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General NPI Number Information
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NPI Number | 1902408859
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Entity Type | Individual
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Provider Name | RAYFORD D BAGSBY JR. PHARM D
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Gender | Male
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Dates
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Enumeration Date | 11/14/2020
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Last Update Date | 11/14/2020
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Provider Practice Location Address
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Address Line | 713 WALTON DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-4108
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Country | US
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Telephone | 678-583-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 713 WALTON DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-4108
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Country | US
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Telephone | 678-588-2541
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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 | RPH023222
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License Number State | GA
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