Provider Demographics
NPI:1831537596
Name:ZACHERY-PHILLIPS, VADIETRICH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VADIETRICH
Middle Name:
Last Name:ZACHERY-PHILLIPS
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 1:2000 MIRROR LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-2124
Mailing Address - Country:US
Mailing Address - Phone:678-840-8788
Mailing Address - Fax:
Practice Address - Street 1:2000 MIRROR LAKE BLVD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-2124
Practice Address - Country:US
Practice Address - Phone:678-840-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018456183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist