Provider Demographics
NPI:1215065768
Name:PRICE, DOROTHY B (RPH)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:B
Last Name:PRICE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:PRICE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MR
Mailing Address - Street 1:140 CROOKED CREEK LANE
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643
Mailing Address - Country:US
Mailing Address - Phone:229-263-4796
Mailing Address - Fax:
Practice Address - Street 1:1060 LAKES BOULEVARD
Practice Address - Street 2:WINN DIXIE #32
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636
Practice Address - Country:US
Practice Address - Phone:229-559-7736
Practice Address - Fax:229-559-3190
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115961835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear