Provider Demographics
NPI:1225387053
Name:TRADO, DENNIS LESTER (RPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:LESTER
Last Name:TRADO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1044 FURYS FERRY RD
Mailing Address - Street 2:CVS PHARMACY
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-231-8359
Mailing Address - Fax:706-860-2359
Practice Address - Street 1:1415 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-231-8359
Practice Address - Fax:706-860-2390
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA117331835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric