NPI 1295150332

Matthew Disharoon

Practitioner Pharmacist Lavonia, GA

Practice location

Address: 13387 Jones St, Lavonia, GA 30553-1164
Phone: (706) 356-4153
Mailing address: 243 Seagraves Dr, Athens, GA 30605-2454

Registered specialties

Pharmacist Primary

Pharmacy Service Providers Taxonomy 183500000X Licence RPH027295 (GA)

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Registry record

NPI: 1295150332
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Feb 2014
Record last updated: 26 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.