Healthcare Provider Details

I. General information

NPI: 1699815050
Provider Name (Legal Business Name): NEIL W GRICE PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3830 WASHINGTON RD STE 11
MARTINEZ GA
30907-5075
US

IV. Provider business mailing address

1124 HUNTERS CV
EVANS GA
30809-6903
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-6654
  • Fax: 706-210-8017
Mailing address:
  • Phone: 706-210-6654
  • Fax: 706-210-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number17155
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: