=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295322998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RASHADA MCGHEE MASOLIAH CPHT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2020
-----------------------------------------------------
Last Update Date | 12/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1970 INDIAN SPRINGS DR SW
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30008-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-320-1476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1970 INDIAN SPRINGS DR SW
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30008-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-320-1476
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | PHTC010542
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------