Provider Demographics
NPI:1316940273
Name:FINCHAM, JACK E (PHD, RPH)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:E
Last Name:FINCHAM
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 WESLEY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-7052
Mailing Address - Country:US
Mailing Address - Phone:706-542-5311
Mailing Address - Fax:706-583-0034
Practice Address - Street 1:262 D W BROOKS DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5016
Practice Address - Country:US
Practice Address - Phone:706-542-5311
Practice Address - Fax:706-583-0034
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103051835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy