Provider Demographics
NPI:1992080675
Name:WIMBERLY, WARNITRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WARNITRA
Middle Name:
Last Name:WIMBERLY
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 1:880 HWY 85 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:678-817-4787
Mailing Address - Fax:678-817-4808
Practice Address - Street 1:880 GLYNN ST S
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2001
Practice Address - Country:US
Practice Address - Phone:678-817-4787
Practice Address - Fax:678-817-4808
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist