Provider Demographics
NPI:1447569694
Name:PARTRIDGE, WALLACE ALLEN JR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:WALLACE
Middle Name:ALLEN
Last Name:PARTRIDGE
Suffix:JR
Gender:M
Credentials:PHARMACIST
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Mailing Address - Street 1:5104 WRIGHTSBORO RD.
Mailing Address - Street 2:FRED'S PHARMACY 1699
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813
Mailing Address - Country:US
Mailing Address - Phone:706-210-7545
Mailing Address - Fax:706-210-9578
Practice Address - Street 1:5104 WRIGHTSBORO RD.
Practice Address - Street 2:FRED'S PHARMACY 1699
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813
Practice Address - Country:US
Practice Address - Phone:706-210-7545
Practice Address - Fax:706-210-9578
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
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Provider Licenses
StateLicense IDTaxonomies
GA10760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist