Provider Demographics
NPI:1467500207
Name:TOWNSEND, JOHN STANFORD (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:STANFORD
Last Name:TOWNSEND
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:PO BOX 190
Mailing Address - Street 2:1 CYPRESS STREET
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-0190
Mailing Address - Country:US
Mailing Address - Phone:912-545-2125
Mailing Address - Fax:912-545-2134
Practice Address - Street 1:1 CYPRESS STREET
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-0190
Practice Address - Country:US
Practice Address - Phone:912-545-2125
Practice Address - Fax:912-545-2134
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00507999AMedicaid
GA1137858OtherNABP