Provider Demographics
NPI:1629377072
Name:FANNIN, HUGH BURCH (RPH)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:BURCH
Last Name:FANNIN
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 1:388 EUHARLEE RD SW
Mailing Address - Street 2:
Mailing Address - City:EUHARLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-6111
Mailing Address - Country:US
Mailing Address - Phone:770-361-3144
Mailing Address - Fax:
Practice Address - Street 1:388 EUHARLEE RD SW
Practice Address - Street 2:
Practice Address - City:EUHARLEE
Practice Address - State:GA
Practice Address - Zip Code:30120-6111
Practice Address - Country:US
Practice Address - Phone:770-361-3144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist