Individual
BLAKE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1200 NORTHSIDE FORSYTH DR, CUMMING, GA 30041-7659
(770) 844-3200
Mailing address
4025 MCGINNIS FERRY RD APT 1119, SUWANEE, GA 30024-8330
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH025662
GA
Other
Enumeration date
03/15/2019
Last updated
03/15/2019
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