Provider Demographics
NPI:1891018735
Name:O'LOUGHLIN, DEANA (RPH)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:O'LOUGHLIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5590 MABLETON PKWY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3342
Mailing Address - Country:US
Mailing Address - Phone:770-745-5635
Mailing Address - Fax:770-745-7121
Practice Address - Street 1:5590 MABLETON PKWY SW STE 100
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3342
Practice Address - Country:US
Practice Address - Phone:770-745-5635
Practice Address - Fax:770-745-7121
Is Sole Proprietor?:No
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist