1740734540 NPI number — GLORIA ANN BOYD PHARMACY TECHNICIAN

Table of content: GLORIA ANN BOYD PHARMACY TECHNICIAN (NPI 1740734540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740734540 NPI number — GLORIA ANN BOYD PHARMACY TECHNICIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
GLORIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACY TECHNICIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WASHINGTON-DAVIS
Provider Other First Name:
GLORIA
Provider Other Middle Name:
LYNETT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMACY TECHNICIAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740734540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 SCHOOL ST
Provider Second Line Business Mailing Address:
APARTMENT D
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31705-2360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-364-8202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 SCHOOL ST
Provider Second Line Business Practice Location Address:
APARTMENT D
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31705-2360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-364-8202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 111900313816 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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