Provider Demographics
NPI:1235891383
Name:MOREHEAD, EMILEE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMILEE
Middle Name:MARIE
Last Name:MOREHEAD
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 1:155 TYLER RD
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-2727
Mailing Address - Country:US
Mailing Address - Phone:229-402-1151
Mailing Address - Fax:
Practice Address - Street 1:620 VIRGINIA AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4227
Practice Address - Country:US
Practice Address - Phone:229-386-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist