Provider Demographics
NPI:1831197961
Name:HARE, AMETA K (RPH)
Entity type:Individual
Prefix:MRS
First Name:AMETA
Middle Name:K
Last Name:HARE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-2004
Mailing Address - Country:US
Mailing Address - Phone:706-517-4007
Mailing Address - Fax:706-226-3786
Practice Address - Street 1:1100 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4185
Practice Address - Country:US
Practice Address - Phone:706-278-8813
Practice Address - Fax:706-226-3786
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist