Provider Demographics
NPI:1326180001
Name:WILLS, CATHY MULLIS (RPH)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:MULLIS
Last Name:WILLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SILVER BROOK TRL
Mailing Address - Street 2:
Mailing Address - City:AMBROSE
Mailing Address - State:GA
Mailing Address - Zip Code:31512-3686
Mailing Address - Country:US
Mailing Address - Phone:229-468-9868
Mailing Address - Fax:
Practice Address - Street 1:270 SILVER BROOK TRL
Practice Address - Street 2:
Practice Address - City:AMBROSE
Practice Address - State:GA
Practice Address - Zip Code:31512-3686
Practice Address - Country:US
Practice Address - Phone:912-384-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15154183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist