Provider Demographics
NPI:1316311392
Name:DRIGGERS, WARREN (PHARMD)
Entity type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:DRIGGERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 BOONE AVE EXT E
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6515
Mailing Address - Country:US
Mailing Address - Phone:912-729-6450
Mailing Address - Fax:
Practice Address - Street 1:1390 BOONE AVE EXT E
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6515
Practice Address - Country:US
Practice Address - Phone:912-729-6450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028806183500000X
FLPS54003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist