Provider Demographics
NPI:1174639959
Name:MOBLEY, BRAD M (PHARMOCIST)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:M
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:PHARMOCIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 GEORGE DEEN RD
Mailing Address - Street 2:
Mailing Address - City:BROXTON
Mailing Address - State:GA
Mailing Address - Zip Code:31519-7112
Mailing Address - Country:US
Mailing Address - Phone:912-359-2734
Mailing Address - Fax:
Practice Address - Street 1:1003 VAN STREAT HIGHWAY
Practice Address - Street 2:
Practice Address - City:NICHOLLS
Practice Address - State:GA
Practice Address - Zip Code:31554
Practice Address - Country:US
Practice Address - Phone:912-345-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPHO16539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist