Provider Demographics
NPI:1659561348
Name:WASSON, AMBER DURRENCE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DURRENCE
Last Name:WASSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3498 HWY 121
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-7102
Mailing Address - Country:US
Mailing Address - Phone:912-654-0543
Mailing Address - Fax:
Practice Address - Street 1:305 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1411
Practice Address - Country:US
Practice Address - Phone:912-739-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-28
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist