Provider Demographics
NPI:1194853366
Name:FRICKS, ELBERT WILLIAM (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ELBERT
Middle Name:WILLIAM
Last Name:FRICKS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:ELBERT
Other - Middle Name:WILLIAM
Other - Last Name:FRICKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:27 SURREY TRL SE
Mailing Address - Street 2:SE
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5946
Mailing Address - Country:US
Mailing Address - Phone:706-291-7235
Mailing Address - Fax:706-291-7235
Practice Address - Street 1:4450 ROCKMART RD SE
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:GA
Practice Address - Zip Code:30173-2438
Practice Address - Country:US
Practice Address - Phone:706-292-0106
Practice Address - Fax:706-292-0647
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist