Provider Demographics
NPI:1871015313
Name:LANDON, JOAN BOATRIGHT (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:BOATRIGHT
Last Name:LANDON
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 1:1312 PLANT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-3537
Mailing Address - Country:US
Mailing Address - Phone:912-285-7281
Mailing Address - Fax:912-285-7546
Practice Address - Street 1:1312 PLANT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-3537
Practice Address - Country:US
Practice Address - Phone:912-285-7281
Practice Address - Fax:912-285-7546
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2017-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010378183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist