Provider Demographics
NPI:1083997001
Name:MAINS, PATRICK J (RPH)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:J
Last Name:MAINS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5550 PARKWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-247-8144
Mailing Address - Fax:706-247-8135
Practice Address - Street 1:5550 PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-247-8144
Practice Address - Fax:706-247-8135
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPH11859183500000X
GARPH031340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist