Provider Demographics
NPI:1790898286
Name:PARTRIDGE, WAYNE BUTLER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:BUTLER
Last Name:PARTRIDGE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:BUTLER
Other - Last Name:PARTRIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1934 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-5132
Mailing Address - Country:US
Mailing Address - Phone:706-790-0820
Mailing Address - Fax:
Practice Address - Street 1:1 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6258
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:706-731-7258
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH#012210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist