Provider Demographics
NPI:1255939815
Name:REDDOCK, JODI L (RPH)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:REDDOCK
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 1:1121 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-7505
Mailing Address - Country:US
Mailing Address - Phone:478-231-9524
Mailing Address - Fax:
Practice Address - Street 1:1121 9TH AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-7505
Practice Address - Country:US
Practice Address - Phone:478-231-9524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist