Provider Demographics
NPI:1255086948
Name:OZMENT, DAVID REGINALD (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:REGINALD
Last Name:OZMENT
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 1:387 S AVERY RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-7972
Mailing Address - Country:US
Mailing Address - Phone:706-346-4404
Mailing Address - Fax:
Practice Address - Street 1:3402 ALABAMA HWY NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-9652
Practice Address - Country:US
Practice Address - Phone:706-234-7616
Practice Address - Fax:706-234-7156
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist