Provider Demographics
NPI:1568035442
Name:MONTGOMERY, DENNIS TYRONE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:TYRONE
Last Name:MONTGOMERY
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 1:205 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-3160
Mailing Address - Country:US
Mailing Address - Phone:706-298-4928
Mailing Address - Fax:706-298-4929
Practice Address - Street 1:205 VERNON ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-3160
Practice Address - Country:US
Practice Address - Phone:706-298-4928
Practice Address - Fax:706-298-4929
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist