=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982187894
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SONYA FLAKES PADGETT PHARM D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2018
-----------------------------------------------------
Last Update Date | 09/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4819 WINDSOR SPRING RD
-----------------------------------------------------
City | HEPHZIBAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30815-4848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-592-4646
-----------------------------------------------------
Fax | 706-592-4618
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 265
-----------------------------------------------------
City | HEPHZIBAH
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30815-0265
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-592-4646
-----------------------------------------------------
Fax | 706-592-4618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHRE010651
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------