Provider Demographics
NPI:1275575086
Name:GRAGG, WILLIAM DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:GRAGG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 COASTLINE ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213
Mailing Address - Country:US
Mailing Address - Phone:770-964-6674
Mailing Address - Fax:
Practice Address - Street 1:451 WEST BANKHEAD HWY
Practice Address - Street 2:SUITE 146
Practice Address - City:WILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-459-5741
Practice Address - Fax:770-459-2288
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist