Individual
MIN PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3618 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281-4171
(770) 474-5309
Mailing address
3618 HIGHWAY 138 SE, STOCKBRIDGE, GA 30281-4171
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
RPH030772
GA
Other
Enumeration date
01/20/2020
Last updated
01/20/2020
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