Healthcare Provider Details

I. General information

NPI: 1003363276
Provider Name (Legal Business Name): GARY PARTLOW RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 DULUTH HWY
LAWRENCEVILLE GA
30046-7645
US

IV. Provider business mailing address

4605 JEFFERSON LN SW
LILBURN GA
30047-4264
US

V. Phone/Fax

Practice location:
  • Phone: 770-822-0788
  • Fax:
Mailing address:
  • Phone: 770-822-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberGA014157
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: