Provider Demographics
NPI:1760562623
Name:VEST, DAVID NELSON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NELSON
Last Name:VEST
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 1:208 SAMANDA CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2183
Mailing Address - Country:US
Mailing Address - Phone:770-684-7385
Mailing Address - Fax:
Practice Address - Street 1:114 S MARBLE ST
Practice Address - Street 2:701-B HOGUE AVE
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2642
Practice Address - Country:US
Practice Address - Phone:770-684-6573
Practice Address - Fax:770-684-4553
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018957183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA018957OtherGA PHARMACIST LICENSE #