Provider Demographics
NPI:1104002252
Name:ELROD, JIM G (RPH)
Entity type:Individual
Prefix:
First Name:JIM
Middle Name:G
Last Name:ELROD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8742
Mailing Address - Country:US
Mailing Address - Phone:706-278-1900
Mailing Address - Fax:706-275-6655
Practice Address - Street 1:1101 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8742
Practice Address - Country:US
Practice Address - Phone:706-278-1900
Practice Address - Fax:706-275-6655
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist