Provider Demographics
NPI:1003363276
Name:PARTLOW, GARY (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:PARTLOW
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 1:4605 JEFFERSON LN SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-4264
Mailing Address - Country:US
Mailing Address - Phone:770-822-0788
Mailing Address - Fax:
Practice Address - Street 1:698 DULUTH HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7645
Practice Address - Country:US
Practice Address - Phone:770-822-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA0141571835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA014157OtherGEORGIA BOARD OF PHARMACY