=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861245086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES AHN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2024
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 SPRING ST
-----------------------------------------------------
City | TALLAPOOSA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30176-1293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-574-2914
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 LAWTON ST NW
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30165-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-234-0900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH034718
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------