Provider Demographics
NPI:1740734540
Name:BOYD, GLORIA ANN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANN
Last Name:BOYD
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:LYNETT
Other - Last Name:WASHINGTON-DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY TECHNICIAN
Mailing Address - Street 1:102 SCHOOL ST
Mailing Address - Street 2:APARTMENT D
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-2360
Mailing Address - Country:US
Mailing Address - Phone:229-364-8202
Mailing Address - Fax:
Practice Address - Street 1:102 SCHOOL ST
Practice Address - Street 2:APARTMENT D
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-2360
Practice Address - Country:US
Practice Address - Phone:229-364-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111900313816Medicaid