Provider Demographics
NPI:1205190790
Name:PATE, ALYSSA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:PATE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205B E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-1121
Mailing Address - Country:US
Mailing Address - Phone:229-794-2750
Mailing Address - Fax:
Practice Address - Street 1:205B E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-1121
Practice Address - Country:US
Practice Address - Phone:229-794-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist