Michael Tate Azzolin, PHARM.D.
Individual provider Active NPI Pharmacist · Bishop, GA
NPI 1588090153 · NPPES record last updated Sep 16, 2013
Key facts
- NPI
- 1588090153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH021293 (GA)
- Practice address
- 1500 Lane Creek Dr
Bishop, GA 30621-1188 - Phone
- (706) 224-3881
- Fax
- (706) 389-9501
- NPI assigned
- Sep 16, 2013
- Sex
- Male
- 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 |
|---|---|---|---|
| RPH021293 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH021293 | GA | Yes |
Addresses
Primary practice location
1500 Lane Creek Dr
Bishop, GA 30621-1188
Mailing address
1500 Lane Creek Dr
Bishop, GA 30621-1188
Phone (706) 224-3881
Other providers in Bishop, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2013. 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.