Provider Demographics
NPI:1598908303
Name:NANCE, DAVID T (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:T
Last Name:NANCE
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 1:79 DOVE DR
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-7014
Mailing Address - Country:US
Mailing Address - Phone:706-327-0551
Mailing Address - Fax:
Practice Address - Street 1:5750 MILGEN RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-2443
Practice Address - Country:US
Practice Address - Phone:706-561-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH011523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist