Provider Demographics
NPI:1225336662
Name:WADE, MARY ANN MEREDITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:MEREDITH
Last Name:WADE
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 1:304 WAKEFIELD LN N
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8920
Mailing Address - Country:US
Mailing Address - Phone:706-854-0608
Mailing Address - Fax:
Practice Address - Street 1:377 FURYS FERRY RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-3047
Practice Address - Country:US
Practice Address - Phone:706-854-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist