Provider Demographics
NPI:1861097636
Name:ADDISON, ADRRYL (PHARMD)
Entity type:Individual
Prefix:
First Name:ADRRYL
Middle Name:
Last Name:ADDISON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ADRRYL
Other - Middle Name:
Other - Last Name:ADDISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:11205 ALPHARETTA HWY STE F1
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1444
Mailing Address - Country:US
Mailing Address - Phone:844-863-0545
Mailing Address - Fax:
Practice Address - Street 1:11205 ALPHARETTA HWY STE F1
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1444
Practice Address - Country:US
Practice Address - Phone:844-863-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0201541835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty