Provider Demographics
NPI:1053694224
Name:BARNICOAT, DEANNA KAY (RPH)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:KAY
Last Name:BARNICOAT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 STILLWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2524
Mailing Address - Country:US
Mailing Address - Phone:404-849-1388
Mailing Address - Fax:
Practice Address - Street 1:2893 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2929
Practice Address - Country:US
Practice Address - Phone:404-841-5605
Practice Address - Fax:404-841-5705
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist