Provider Demographics
NPI:1134469729
Name:BARROW, JOHN MACK (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MACK
Last Name:BARROW
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 1:105 SWEET BRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5741
Mailing Address - Country:US
Mailing Address - Phone:678-592-7845
Mailing Address - Fax:
Practice Address - Street 1:108 PAVILION PKWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4056
Practice Address - Country:US
Practice Address - Phone:770-460-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist