MEDICARE: TONI LYNN PRINE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	17877	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17877	OTHER	GA	STATE BOARD OF PHARMACY

General Provider Information

NPI Number	:	1144491689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI LYNN PRINE RPH

Provider Business Mailing Address
First Line	:	2 PEACHTREE ST NW
Second Line	:	5TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30303-3141
Country	:	US
Telephone Number	:	404-463-7487
Fax Number	:	866-899-9772

Provider Business Practice Location Address
First Line	:	2 PEACHTREE ST NW
Second Line	:	5TH FLOOR
City	:	ATLANTA
State	:	GA
Zip	:	30303-3141
Country	:	US
Telephone Number	:	404-463-7487
Fax Number	:	866-899-9772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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