Healthcare Provider Details

I. General information

NPI: 1386982619
Provider Name (Legal Business Name): ADRIAN PENNY SYKES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

4325 ATLANTA HWY
LOGANVILLE GA
30052-2341
US

IV. Provider business mailing address

4325 ATLANTA HWY
LOGANVILLE GA
30052-2341
US

V. Phone/Fax

Practice location:
  • Phone: 770-466-5156
  • Fax: 770-466-2067
Mailing address:
  • Phone: 770-466-5156
  • Fax: 770-466-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: