Wallace Allen Partridge Jr., PHARMACIST

Primary specialty

PharmacistTaxonomy code 183500000X

License

10760 Issued in GA

Practice address

5104 Wrightsboro Rd.
Fred'S Pharmacy 1699
Grovetown, GA 30813

Phone

(706) 210-7545

Fax

(706) 210-9578

NPI assigned

Oct 5, 2010

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286236800000",
    "number": "1447569694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 WRIGHTSBORO RD.",
            "address_2": "FRED'S PHARMACY 1699",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "30813",
            "telephone_number": "706-210-7545",
            "fax_number": "706-210-9578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5104 WRIGHTSBORO RD.",
            "address_2": "FRED'S PHARMACY 1699",
            "city": "GROVETOWN",
            "state": "GA",
            "postal_code": "30813",
            "telephone_number": "706-210-7545",
            "fax_number": "706-210-9578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARTRIDGE",
        "first_name": "WALLACE",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PHARMACIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "10760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chelsea Nicole Overby, PMHNP
• Ronald Edwin Owens II, DMD
• Kyley Pahe, MS, RD, LD
• Terance Parker
• Tiffany Nicole Parks, M.D.
• Jay M. Patel, PHARM.D.
• Paterson Pediatric Therapy LLC
• Patriots Park Dental
• Peacceful at Home LLC
• Yashate Kinkia Pendergrass, RN

• Pharmacist in Grovetown, GA
• Providers in Grovetown, GA by specialty
• Pharmacist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.