Healthcare Provider Details

I. General information

NPI: 1134711559
Provider Name (Legal Business Name): ISAAC PLEMONS PHARMD, RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4216 CHESTNUT TRL
COHUTTA GA
30710-9375
US

IV. Provider business mailing address

4216 CHESTNUT TRL
COHUTTA GA
30710-9375
US

V. Phone/Fax

Practice location:
  • Phone: 706-537-9431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: