Healthcare Provider Details

I. General information

NPI: 1730573411
Provider Name (Legal Business Name): GINA POWELL RPH PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 SPRING VALLEY WAY
BISHOP GA
30621-1340
US

IV. Provider business mailing address

1061 SPRING VALLEY WAY
BISHOP GA
30621-1340
US

V. Phone/Fax

Practice location:
  • Phone: 706-255-1553
  • Fax:
Mailing address:
  • Phone: 706-255-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18785
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40589
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH017647
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: