Provider Demographics
NPI:1730487000
Name:RADER, DEANNA LEIGH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:LEIGH
Last Name:RADER
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 1:3687 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2385
Mailing Address - Country:US
Mailing Address - Phone:770-577-8979
Mailing Address - Fax:770-577-0827
Practice Address - Street 1:3687 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2385
Practice Address - Country:US
Practice Address - Phone:770-577-8979
Practice Address - Fax:770-577-0827
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist