Provider Demographics
NPI:1770838963
Name:WADE, MARGARET C (RPH)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:WADE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BULLSBORO DR
Mailing Address - Street 2:T-1223
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1045
Mailing Address - Country:US
Mailing Address - Phone:770-502-0294
Mailing Address - Fax:
Practice Address - Street 1:555 BULLSBORO DR
Practice Address - Street 2:T-1223
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1045
Practice Address - Country:US
Practice Address - Phone:770-502-0294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016581183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist