1912451246 NPI number — MR. VICTOR RAY VOISELLE RPH.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912451246 NPI number — MR. VICTOR RAY VOISELLE RPH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VOISELLE
Provider First Name:
VICTOR
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912451246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2087
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESBORO
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30459-2087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-764-8234
Provider Business Mailing Address Fax Number:
912-489-4109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 B PARKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLET
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30415-0215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-842-9886
Provider Business Practice Location Address Fax Number:
912-842-9890
Provider Enumeration Date:
08/03/2016

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: 183500000X , with the licence number:  RPH019513 , 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: PHRE008690 . This is a "PHARMACIST IN CHARGE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 002868998 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RPH019513 . This is a "STATE PHARMACIST LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com