Provider Demographics
NPI:1194362186
Name:PATRICK, CHEKESHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHEKESHA
Middle Name:
Last Name:PATRICK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ALAIA
Other - Middle Name:
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3721 NEW MACLAND RD # 200-308
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2000
Mailing Address - Country:US
Mailing Address - Phone:404-402-4352
Mailing Address - Fax:
Practice Address - Street 1:5157 JIMMY LEE SMITH PKWY STE 107
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2786
Practice Address - Country:US
Practice Address - Phone:678-324-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist