Provider Demographics
NPI:1912451246
Name:VOISELLE, VICTOR RAY (RPH)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:RAY
Last Name:VOISELLE
Suffix:
Gender:M
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459-2087
Mailing Address - Country:US
Mailing Address - Phone:912-764-8234
Mailing Address - Fax:912-489-4109
Practice Address - Street 1:114 B PARKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-0215
Practice Address - Country:US
Practice Address - Phone:912-842-9886
Practice Address - Fax:912-842-9890
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE008690OtherPHARMACIST IN CHARGE
GA002868998Medicaid
GARPH019513OtherSTATE PHARMACIST LICENSE
GA6099480001Medicare PIN