Provider Demographics
NPI:1285048678
Name:FERRIS, LINDA (PHARMD MDIV)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FERRIS
Suffix:
Gender:F
Credentials:PHARMD MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 FLOWERING DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1878
Mailing Address - Country:US
Mailing Address - Phone:770-609-8883
Mailing Address - Fax:
Practice Address - Street 1:2131 FLOWERING DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1878
Practice Address - Country:US
Practice Address - Phone:770-609-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0168531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist