Provider Demographics
NPI:1881025518
Name:FLEET, BARRY (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:FLEET
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 OLD MCDONOUGH HWY SE
Mailing Address - Street 2:APT. 208
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5937
Mailing Address - Country:US
Mailing Address - Phone:404-917-4331
Mailing Address - Fax:
Practice Address - Street 1:4104 TATE ST NE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2551
Practice Address - Country:US
Practice Address - Phone:770-917-4331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-05
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014452183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist