Provider Demographics
NPI:1316541907
Name:MONK, PAULA (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MONK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-9154
Mailing Address - Country:US
Mailing Address - Phone:706-302-9746
Mailing Address - Fax:706-882-9383
Practice Address - Street 1:1802 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3822
Practice Address - Country:US
Practice Address - Phone:706-882-5564
Practice Address - Fax:706-882-9383
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist