DR. MARLA MARIE MITCHAM (NPI# 1043822067) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043822067 |
| Entity Type | Individual |
| Full Name | DR. MARLA MARIE MITCHAM |
| Credential | PHARMD |
| Practice Address |
100 Myrtle Blvd. Pharmacy Bldg. 15 Room G12 Gracewood GA 30812 |
| Practice Telephone | 7067902496 |
| Practice Fax Number | 7067902340 |
| Mailing Telephone | 7067902496 |
| Mailing Fax Number | 7067902340 |
| Enumeration Date | 2020-08-20 |
| Last Update Date | 2020-08-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | RPH029883 | GA | Pharmacy Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | PHARMACIST LICENSE | RPH029883 | 01 |
| Street Address |
100 MYRTLE BLVD. PHARMACY BLDG. 15 ROOM G12 |
| City | GRACEWOOD |
| State | GA |
| Zip Code | 30812 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932571312 | Holli E Pender | Pharmacist | 100 Myrtle Blvd., Gracewood, GA 30812 | 2015-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295163277 | Melissa B Lynch | Contractor | 1523 Keron Way, Gracewood, GA 30812 | 2013-10-29 |
| 1104330398 | Sopheap Pin | Pharmacist | 100 Myrtle Blvd, Dept of Pharmacy, Gracewood, GA 30812 | 2017-11-27 |
| 1427434273 | Cynthia Bass Kucela | Pharmacist | 100 Myrtle Blvd, East Central Regional Hospital Dept of Pharmacy, Gracewood, GA 30812 | 2015-08-04 |
| 1013391119 | Hasim Momin | Dentist | 100 Myrtle Blvd, Gracewood, GA 30812 | 2015-07-17 |
| 1629463864 | Inoka Abeysiri Devapriya | Surgery | 100 Myrtle Blvd, 103b, Gracewood, GA 30812 | 2015-04-04 |
| 1962720664 | Eliza A Myers | Dentist | 100 Myrtle Blvd, East Central Regional Hospital, Gracewood, GA 30812 | 2010-05-06 |
| 1639166234 | Ga Department of Human Resources | Skilled Nursing Facility | 100 Myrtle Blvd, Gracewood, GA 30812-1500 | 2005-09-29 |
| 1992036909 | Department of Behavioral Health and Developmental Disabilities | Pharmacy | 100 Myrtle Blvd, Gracewood, GA 30812-1500 | 2010-01-15 |
| 1699000703 | Department of Behavioral Health and Developmental Disabilities | Intermediate Care Facility, Mentally Retarded | 100 Myrtle Blvd, Gracewood, GA 30812-1500 | 2009-10-07 |
| 1053646166 | Department of Behavioral Health and Developmental Disabilities | Skilled Nursing Facility | 100 Myrtle Blvd, Gracewood, GA 30812-1500 | 2009-10-07 |
| Find all providers in zip 30812 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932571312 | Holli E Pender | Pharmacist | 100 Myrtle Blvd., Gracewood, GA 30812 | 2015-10-26 |
| 1104330398 | Sopheap Pin | Pharmacist | 100 Myrtle Blvd, Dept of Pharmacy, Gracewood, GA 30812 | 2017-11-27 |
| 1427434273 | Cynthia Bass Kucela | Pharmacist | 100 Myrtle Blvd, East Central Regional Hospital Dept of Pharmacy, Gracewood, GA 30812 | 2015-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215538103 | Agatha Nonye Okoye | Pharmacist | 5300 Bridle Point Pkwy, Snellville, GA 30039-2715 | 2020-11-05 |
| 1861093155 | Mohamed J Bah | Pharmacist | 2965 Olivine Dr, Dacula, GA 30019-7646 | 2020-11-04 |
| 1841891249 | Himanshu Haridutt Desai | Pharmacist | 30983 Us-441 S, Commerce, GA 30529 | 2020-11-03 |
| 1720689219 | Olubunmi Adeniyi | Pharmacist | 524 Serene Waters Trl, Jonesboro, GA 30236-5495 | 2020-11-03 |
| 1174124572 | Jessica Rodriguez New | Pharmacist | 2892 Browns Bridge Road, Gainesville, GA 30504 | 2020-11-03 |
| 1063013613 | John Ellis Iv | Pharmacist | 135 Rudders Xing, Newnan, GA 30263-7032 | 2020-11-02 |
| 1992306591 | Connie Deverell Tam | Pharmacist | Walmart Pharmacy #1658, 2205 Harrison Rd, Thomson, GA 30824 | 2020-11-02 |
| 1922608520 | Sylvia Adams | Pharmacist | 1173 W Briar Gate Ct, Riverdale, GA 30296-3378 | 2020-11-01 |
| 1417557000 | Birtukan Tsegaye | Pharmacist | 2715 Henderson Rd, Tucker, GA 30084-2432 | 2020-10-31 |
| 1528668175 | Vishwa Patel | Pharmacist | 3604 Bellhaven Dr, Valdosta, GA 31605-1210 | 2020-10-31 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.