Provider Demographics
NPI:1578167490
Name:KIRT, ELLA DOZIER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELLA
Middle Name:DOZIER
Last Name:KIRT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-2767
Mailing Address - Country:US
Mailing Address - Phone:770-474-7926
Mailing Address - Fax:
Practice Address - Street 1:80 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2767
Practice Address - Country:US
Practice Address - Phone:770-474-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0015590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist