Provider Demographics
NPI:1558644039
Name:MATHIS, STEVEN LAIRD (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LAIRD
Last Name:MATHIS
Suffix:
Gender:M
Credentials:PHARMD
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Mailing Address - Street 1:950 TOWNE LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1601
Mailing Address - Country:US
Mailing Address - Phone:770-924-0172
Mailing Address - Fax:770-924-2638
Practice Address - Street 1:950 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-1601
Practice Address - Country:US
Practice Address - Phone:770-924-0172
Practice Address - Fax:770-924-2638
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARPH021132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist