Healthcare Provider Details

I. General information

NPI: 1689128720
Provider Name (Legal Business Name): DENISA DEMIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
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

2511 CASCADE CT
GROVETOWN GA
30813-3376
US

V. Phone/Fax

Practice location:
  • Phone: 706-619-2248
  • Fax:
Mailing address:
  • Phone: 313-953-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH029341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: