Provider Demographics
NPI:1366179590
Name:FORD, OCTAVIAN DEMETRIUS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:OCTAVIAN
Middle Name:DEMETRIUS
Last Name:FORD
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 1:112 ADAIR ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-1704
Mailing Address - Country:US
Mailing Address - Phone:912-228-2284
Mailing Address - Fax:
Practice Address - Street 1:402 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:GLENNVILLE
Practice Address - State:GA
Practice Address - Zip Code:30427-1772
Practice Address - Country:US
Practice Address - Phone:912-654-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist