Provider Demographics
NPI:1285114843
Name:LARGENT, JORG RICHARD JR (BS PHARM)
Entity type:Individual
Prefix:MR
First Name:JORG
Middle Name:RICHARD
Last Name:LARGENT
Suffix:JR
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:LARGENT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1761 CHANSON PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2169
Mailing Address - Country:US
Mailing Address - Phone:404-808-1871
Mailing Address - Fax:
Practice Address - Street 1:1761 CHANSON PL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2169
Practice Address - Country:US
Practice Address - Phone:404-808-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist