Provider Demographics
NPI:1841538089
Name:SARGENTCOLEMAN, NEEDRA GESELLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:NEEDRA
Middle Name:GESELLE
Last Name:SARGENTCOLEMAN
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 1:3649 FLAKES MILL RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5218
Mailing Address - Country:US
Mailing Address - Phone:770-322-2380
Mailing Address - Fax:
Practice Address - Street 1:3649 FLAKES MILL RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5218
Practice Address - Country:US
Practice Address - Phone:770-322-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist