Provider Demographics
NPI:1427728740
Name:VICKERS, CHLOE LEE (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:LEE
Last Name:VICKERS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 CONWAY VICKERS RD
Mailing Address - Street 2:
Mailing Address - City:AMBROSE
Mailing Address - State:GA
Mailing Address - Zip Code:31512-3733
Mailing Address - Country:US
Mailing Address - Phone:912-309-0229
Mailing Address - Fax:
Practice Address - Street 1:602 PETERSON AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5233
Practice Address - Country:US
Practice Address - Phone:912-260-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist