Provider Demographics
NPI:1598352734
Name:REESE, FARRAH NICOLE (CPHT)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:NICOLE
Last Name:REESE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:DEARING
Mailing Address - State:GA
Mailing Address - Zip Code:30808-3322
Mailing Address - Country:US
Mailing Address - Phone:706-466-6873
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC001327183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician