Provider Demographics
NPI:1376133389
Name:HARPER, DWIGHT MILLS (RPH)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:MILLS
Last Name:HARPER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9881 COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30747-1300
Mailing Address - Country:US
Mailing Address - Phone:706-808-1100
Mailing Address - Fax:706-808-1103
Practice Address - Street 1:9881 COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-1300
Practice Address - Country:US
Practice Address - Phone:706-808-1100
Practice Address - Fax:706-808-1103
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH016698OtherGEORGIA BOARD OF PHARMACY
GA016698OtherGEORGIA BOARD OF PHARMACY
GA016698OtherPHARMACIST