Provider Demographics
NPI:1861090516
Name:NAIKE-PETERS, GRETA SHANE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GRETA
Middle Name:SHANE
Last Name:NAIKE-PETERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6989
Mailing Address - Country:US
Mailing Address - Phone:770-932-4373
Mailing Address - Fax:
Practice Address - Street 1:400 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6989
Practice Address - Country:US
Practice Address - Phone:770-932-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029193183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist