Healthcare Provider Details

I. General information

NPI: 1407194756
Provider Name (Legal Business Name): REBECCA SHEAD MAYS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA LYNN STROBLE PHARM.D.

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CARLTON DR
LEESBURG GA
31763-5652
US

IV. Provider business mailing address

125 CARLTON DR
LEESBURG GA
31763-5652
US

V. Phone/Fax

Practice location:
  • Phone: 229-814-8443
  • Fax: 229-814-8444
Mailing address:
  • Phone: 229-814-8443
  • Fax: 229-814-8444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH020550
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: