Provider Demographics
NPI:1740875624
Name:JOSEPH, TEVIN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:TEVIN
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PRESERVE PKWY
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-3228
Mailing Address - Country:US
Mailing Address - Phone:770-882-8799
Mailing Address - Fax:
Practice Address - Street 1:1100 OLD PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4045
Practice Address - Country:US
Practice Address - Phone:706-301-9076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist