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General NPI Number Information
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NPI Number | 1720368368
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Entity Type | Individual
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Provider Name | MR. ROBERT WILTON FLETCHER III
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Gender | Male
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 5963 SPOUT SPRINGS RD
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3452
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Country | US
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Telephone | 770-965-2371
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Fax | 770-965-7330
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Provider Business Mailing Address
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Address Line | 5963 SPOUT SPRINGS RD
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-3452
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Country | US
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Telephone | 770-965-2371
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Fax | 770-965-7330
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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 | RPH020845
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License Number State | GA
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