Healthcare Provider Details

I. General information

NPI: 1457866840
Provider Name (Legal Business Name): WILLIAM BURT WRENN III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 12/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 EXPERIMENT STATION RD
WATKINSVILLE GA
30677-5328
US

IV. Provider business mailing address

2061 EXPERIMENT STATION RD
WATKINSVILLE GA
30677-5328
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-2080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025436
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: