Provider Demographics
NPI:1790152569
Name:OLIVER, DEON TERREL JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DEON
Middle Name:TERREL
Last Name:OLIVER
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LITTLE JOE CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3100
Mailing Address - Country:US
Mailing Address - Phone:404-242-0526
Mailing Address - Fax:
Practice Address - Street 1:140 LITTLE JOE CT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3100
Practice Address - Country:US
Practice Address - Phone:404-242-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist