Provider Demographics
NPI:1285362467
Name:POOLER, JESSE GORDON III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:GORDON
Last Name:POOLER
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 PRINCE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-4213
Mailing Address - Country:US
Mailing Address - Phone:191-222-0641
Mailing Address - Fax:
Practice Address - Street 1:164 W WIEUCA RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3231
Practice Address - Country:US
Practice Address - Phone:404-255-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist