Provider Demographics
NPI:1295357325
Name:IRELAND, RHONDA
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:IRELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MAIN STREET MARKETPLACE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3507
Mailing Address - Country:US
Mailing Address - Phone:770-386-8160
Mailing Address - Fax:770-387-0697
Practice Address - Street 1:125 MAIN STREET MARKETPLACE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120
Practice Address - Country:US
Practice Address - Phone:770-386-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0183841835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist