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General NPI Number Information
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NPI Number | 1932703683
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Entity Type | Individual
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Provider Name | TEKERRA BRANCH RPH
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Gender | Female
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 1025 HILLCREST PKWY
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City | DUBLIN
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State | GA
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Zip | 31021-4209
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Country | US
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Telephone | 478-275-9897
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Fax |
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Provider Business Mailing Address
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Address Line | 436 W BROAD ST
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City | TWIN CITY
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State | GA
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Zip | 30471-4107
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Country | US
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Telephone | 478-494-5157
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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 | RPH031779
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License Number State | GA
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