Provider Demographics
NPI:1720689078
Name:WILLIS, MEREDITH COOK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:COOK
Last Name:WILLIS
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 1:25 HIDDEN COVEY LN
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-7568
Mailing Address - Country:US
Mailing Address - Phone:770-468-2900
Mailing Address - Fax:
Practice Address - Street 1:855 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3622
Practice Address - Country:US
Practice Address - Phone:706-648-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027322183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist