Provider Demographics
NPI:1851695217
Name:PIERCE, JEFFREY SCOTT (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:PIERCE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 EATONTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-4630
Mailing Address - Country:US
Mailing Address - Phone:706-342-3119
Mailing Address - Fax:706-342-3628
Practice Address - Street 1:1441 EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4630
Practice Address - Country:US
Practice Address - Phone:706-342-3119
Practice Address - Fax:706-342-3628
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist