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General NPI Number Information
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NPI Number | 1568710143
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Entity Type | Individual
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Provider Name | UCHE IBIAM-GRESHAM RPH
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Gender | Female
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 2423 US HIGHWAY 80 W
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City | DUBLIN
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State | GA
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Zip | 31021-0930
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Country | US
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Telephone | 478-960-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CHARLOTTE CT
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City | MACON
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State | GA
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Zip | 31220-2665
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Country | US
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Telephone | 770-771-1441
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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 | RPH023449
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License Number State | GA
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