Provider Demographics
NPI:1376123091
Name:PADGETT, QUINTON ANDREWIUS (PHARMD)
Entity Type:Individual
Prefix:
First Name:QUINTON
Middle Name:ANDREWIUS
Last Name:PADGETT
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 1:1377 PIO NONO AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-4633
Mailing Address - Country:US
Mailing Address - Phone:478-742-1448
Mailing Address - Fax:
Practice Address - Street 1:1377 PIO NONO AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-4633
Practice Address - Country:US
Practice Address - Phone:478-742-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist