Provider Demographics
NPI:1538703160
Name:PAMPLIN, MICAELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:PAMPLIN
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 1:24 ALICIA LN STE 3
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1637
Mailing Address - Country:US
Mailing Address - Phone:706-864-0064
Mailing Address - Fax:706-864-0130
Practice Address - Street 1:24 ALICIA LN STE 3
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1637
Practice Address - Country:US
Practice Address - Phone:706-864-0064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty