Provider Demographics
NPI:1831199249
Name:JAGGERS, RONDELL CLAYTON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RONDELL
Middle Name:CLAYTON
Last Name:JAGGERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3260 MILLWOOD TRL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1602
Mailing Address - Country:US
Mailing Address - Phone:678-556-9573
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:GRADY HEALTH SYSTEM PHARMACY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-3141
Practice Address - Fax:404-616-6070
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist