Healthcare Provider Details

I. General information

NPI: 1205210259
Provider Name (Legal Business Name): ALEX GELFAND PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 MAPLE AVE SW
ROME GA
30161-6739
US

IV. Provider business mailing address

2006 MAPLE AVE SW
ROME GA
30161-6739
US

V. Phone/Fax

Practice location:
  • Phone: 706-234-5392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH026842
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: