Provider Demographics
NPI:1083337661
Name:LASSITER, GENE EDWARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:EDWARD
Last Name:LASSITER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 DANIELL MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1361
Mailing Address - Country:US
Mailing Address - Phone:770-789-1032
Mailing Address - Fax:
Practice Address - Street 1:5122 DANIELL MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON
Practice Address - State:GA
Practice Address - Zip Code:30187-1361
Practice Address - Country:US
Practice Address - Phone:770-789-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS13073183500000X
GARPH010394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist