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General NPI Number Information
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NPI Number | 1336553114
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Entity Type | Individual
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Provider Name | DUSTIN HIRSH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 3295 HIGHWAY 124
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City | SNELLVILLE
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State | GA
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Zip | 30039-6113
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Country | US
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Telephone | 770-972-8255
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Fax |
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Provider Business Mailing Address
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Address Line | 100 6TH ST NE APARTMENT 1403
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City | ATLANTA
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State | GA
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Zip | 30308-1302
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Country | US
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Telephone | 412-862-5983
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH027445
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License Number State | GA
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