Provider Demographics
NPI:1427789114
Name:GAYLORD, ALEXIS (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GAYLORD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 NEWSHAW WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-6501
Mailing Address - Country:US
Mailing Address - Phone:770-709-8853
Mailing Address - Fax:
Practice Address - Street 1:285 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-2155
Practice Address - Country:US
Practice Address - Phone:770-867-9723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist