Provider Demographics
NPI:1265118285
Name:EUBANKS, ALLY NELL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ALLY
Middle Name:NELL
Last Name:EUBANKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 TIMBER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5308
Mailing Address - Country:US
Mailing Address - Phone:912-256-8444
Mailing Address - Fax:
Practice Address - Street 1:5475 BETHELVIEW RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9731
Practice Address - Country:US
Practice Address - Phone:678-455-1238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist