Provider Demographics
NPI:1396153383
Name:MABRY, MARY ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:MABRY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANN
Other - Last Name:BOUSQUETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:157 CLINIC AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4454
Mailing Address - Country:US
Mailing Address - Phone:770-812-1919
Mailing Address - Fax:
Practice Address - Street 1:157 CLINIC AVE STE 202
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4454
Practice Address - Country:US
Practice Address - Phone:770-812-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist