Provider Demographics
NPI:1801126982
Name:POOLE, GRACE GRIFFIN (PHARMD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:GRIFFIN
Last Name:POOLE
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 1:208 OLIVER JONES RD
Mailing Address - Street 2:
Mailing Address - City:IDEAL
Mailing Address - State:GA
Mailing Address - Zip Code:31041-5466
Mailing Address - Country:US
Mailing Address - Phone:478-949-2419
Mailing Address - Fax:
Practice Address - Street 1:298 MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068
Practice Address - Country:US
Practice Address - Phone:478-472-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist