Provider Demographics
NPI:1326329715
Name:FITZPATRICK, ADRIENNE QIYAM (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:QIYAM
Last Name:FITZPATRICK
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 1:3505 CENTERVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6405
Mailing Address - Country:US
Mailing Address - Phone:770-736-2157
Mailing Address - Fax:
Practice Address - Street 1:3505 CENTERVILLE HWY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6405
Practice Address - Country:US
Practice Address - Phone:770-736-2157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2013-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist