Provider Demographics
NPI:1710295852
Name:REDLEY, JOSEPH LEROY (PHARM D MPH, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEROY
Last Name:REDLEY
Suffix:
Gender:M
Credentials:PHARM D MPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WHITE TAIL CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4919
Mailing Address - Country:US
Mailing Address - Phone:770-367-6780
Mailing Address - Fax:
Practice Address - Street 1:105 WHITE TAIL CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4919
Practice Address - Country:US
Practice Address - Phone:770-367-6780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist