Provider Demographics
NPI:1003925264
Name:PRICE, JOHN D (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:PRICE
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 MILL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-9060
Mailing Address - Country:US
Mailing Address - Phone:229-468-5929
Mailing Address - Fax:229-468-7313
Practice Address - Street 1:515 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5007
Practice Address - Country:US
Practice Address - Phone:229-468-5929
Practice Address - Fax:229-468-7313
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist