Provider Demographics
NPI:1285232074
Name:PATRICK, CLINT D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:D
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-5481
Mailing Address - Country:US
Mailing Address - Phone:770-402-0903
Mailing Address - Fax:
Practice Address - Street 1:301 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3725
Practice Address - Country:US
Practice Address - Phone:770-954-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH025592OtherBOARD OF PHARMACY