Provider Demographics
NPI:1407200579
Name:ALLY, SAUDIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SAUDIA
Middle Name:
Last Name:ALLY
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 1:930 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-6407
Mailing Address - Country:US
Mailing Address - Phone:770-682-2433
Mailing Address - Fax:
Practice Address - Street 1:930 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6407
Practice Address - Country:US
Practice Address - Phone:770-682-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH028974OtherPHARMACIST LICENSE NUMBER