Provider Demographics
NPI:1659969392
Name:PRATHER, PERRY PATRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:PATRICK
Last Name:PRATHER
Suffix:
Gender:M
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:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-0017
Mailing Address - Country:US
Mailing Address - Phone:706-845-4898
Mailing Address - Fax:706-845-0687
Practice Address - Street 1:136 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-2338
Practice Address - Country:US
Practice Address - Phone:706-884-7301
Practice Address - Fax:706-845-0687
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty