Individual
GRACE ODI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
2902 PEACH ORCHARD RD, AUGUSTA, GA 30906-3504
(706) 650-8224
Mailing address
134 MOSS CREEK DR, MARTINEZ, GA 30907-4517
(706) 650-8224
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
7656
SC
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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