Loretta Walborn, PHARM.D.
Individual provider Active NPI Pharmacist · East Ellijay, GA
NPI 1477965267 · NPPES record last updated Dec 18, 2023
Key facts
- NPI
- 1477965267
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH022564 (GA)
- Practice address
- 192 1St Ave
East Ellijay, GA 30540-8101 - Phone
- (706) 635-2241
- NPI assigned
- May 28, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH022564 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH022564 | GA | Yes |
Addresses
Primary practice location
192 1St Ave
East Ellijay, GA 30540-8101
Mailing address
97 Commerce Drive
Blueridge, GA 30513
Phone (706) 632-9508
Other providers in East Ellijay, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.