Healthcare Provider Details

I. General information

NPI: 1255714440
Provider Name (Legal Business Name): REBECCA SMITH GAY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 HORIZON SOUTH PKWY
GROVETOWN GA
30813-3037
US

IV. Provider business mailing address

898 HORIZON SOUTH PKWY
GROVETOWN GA
30813-3037
US

V. Phone/Fax

Practice location:
  • Phone: 706-619-2248
  • Fax: 706-619-2249
Mailing address:
  • Phone: 706-619-2248
  • Fax: 706-619-2249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH028524
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: