MEDICARE: ELIZABETH S PATRICK RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	13038	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013038	OTHER	GA	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1063412393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH S PATRICK RPH

Provider Business Mailing Address
First Line	:	5940 BROOKGREEN RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5206
Country	:	US
Telephone Number	:	404-303-0327
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 WINN WAY
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1707
Country	:	US
Telephone Number	:	404-508-6449
Fax Number	:	404-508-7733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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