Provider Demographics
NPI:1730495300
Name:PACE, WENESHA PACE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WENESHA
Middle Name:PACE
Last Name:PACE
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 1:1722 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-4234
Mailing Address - Country:US
Mailing Address - Phone:770-477-6848
Mailing Address - Fax:
Practice Address - Street 1:8525 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3405
Practice Address - Country:US
Practice Address - Phone:770-477-6848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024099183500000X
FLPS39078183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist