Provider Demographics
NPI:1043704299
Name:UTZ, ALYSSA ELROD (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ELROD
Last Name:UTZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 WOODIRON DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-3759
Mailing Address - Country:US
Mailing Address - Phone:706-244-8726
Mailing Address - Fax:
Practice Address - Street 1:3495 PIEDMONT ROAD
Practice Address - Street 2:FIRST FLOOR, SUITE 110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-673-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist