Provider Demographics
NPI:1003320326
Name:DODD, JERRICA LANISE (PHARMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JERRICA
Middle Name:LANISE
Last Name:DODD
Suffix:
Gender:F
Credentials:PHARMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 POWDER SPRINGS RD SW
Mailing Address - Street 2:SUITE 190, PMB 295
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4861
Mailing Address - Country:US
Mailing Address - Phone:770-316-5497
Mailing Address - Fax:
Practice Address - Street 1:2499 RED BARN RD SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4905
Practice Address - Country:US
Practice Address - Phone:770-316-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34036183500000X
OH03223091183500000X
GARPH22274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist