Provider Demographics
NPI:1215078969
Name:DENNARD, ADELE DIANE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:DIANE
Last Name:DENNARD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:SOPERTON
Mailing Address - State:GA
Mailing Address - Zip Code:30457-1722
Mailing Address - Country:US
Mailing Address - Phone:912-529-5252
Mailing Address - Fax:912-529-6161
Practice Address - Street 1:119 2ND ST N
Practice Address - Street 2:
Practice Address - City:SOPERTON
Practice Address - State:GA
Practice Address - Zip Code:30457-1177
Practice Address - Country:US
Practice Address - Phone:912-529-4545
Practice Address - Fax:912-529-6161
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH016463183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist