Provider Demographics
NPI:1366267346
Name:GROGAN, DEBORAH (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:GROGAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 AMOS OSBORNE PATH
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-8386
Mailing Address - Country:US
Mailing Address - Phone:404-308-9795
Mailing Address - Fax:
Practice Address - Street 1:537 HARDEE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4711
Practice Address - Country:US
Practice Address - Phone:770-505-0255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist