Gretchen Licud, PHARMD, RPH
Individual provider Active NPI Pharmacist · Stockbridge, GA
NPI 1548044480 · NPPES record last updated Aug 22, 2023
Key facts
- NPI
- 1548044480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH034244 (GA)
- Practice address
- 5095 Mount Zion Pkwy
Stockbridge, GA 30281-7825 - Phone
- (404) 884-9498
- NPI assigned
- Aug 22, 2023
- Sex
- Female
- Sole proprietor
- Yes
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, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH034244 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH034244 | GA | Yes |
Addresses
Primary practice location
5095 Mount Zion Pkwy
Stockbridge, GA 30281-7825
Mailing address
5095 Mount Zion Pkwy
Stockbridge, GA 30281-7825
Phone (404) 884-9498
Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 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.