Healthcare Provider Details

I. General information

NPI: 1902855208
Provider Name (Legal Business Name): ELIZABETH MORGAN MILLSAPS RPH, PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 E BROAD ST
CAMILLA GA
31730-1842
US

IV. Provider business mailing address

88 S SCOTT ST
CAMILLA GA
31730-1716
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-7758
  • Fax: 229-336-5615
Mailing address:
  • Phone: 229-336-7758
  • Fax: 229-336-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number021772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: