Individual
ELA D AMIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS
Contact information
Practice address
500 FURYS FERRY RD, MARTINEZ, GA 30907-7900
(706) 869-1281
Mailing address
593 FIRESTONE PL, MARTINEZ, GA 30907-8956
(706) 925-4979
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
15174
GA
Other
Enumeration date
11/29/2011
Last updated
11/29/2011
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