Provider Demographics
NPI:1730573411
Name:POWELL, GINA (RPH PHARM D)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:RPH PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 SPRING VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1340
Mailing Address - Country:US
Mailing Address - Phone:706-255-1553
Mailing Address - Fax:
Practice Address - Street 1:1061 SPRING VALLEY WAY
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:GA
Practice Address - Zip Code:30621-1340
Practice Address - Country:US
Practice Address - Phone:706-255-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18785183500000X
FLPS40589183500000X
GARPH017647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist