Provider Demographics
NPI:1265711691
Name:LOUDERMILK, JIMMY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:LEE
Last Name:LOUDERMILK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 COLLEGE AVE
Mailing Address - Street 2:UNIT C3
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2616
Mailing Address - Country:US
Mailing Address - Phone:706-621-3169
Mailing Address - Fax:
Practice Address - Street 1:150 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-1701
Practice Address - Country:US
Practice Address - Phone:180-081-8648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0012639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist