Provider Demographics
NPI:1679606925
Name:PARHAM, RENDER TERRELL JR (RPH)
Entity type:Individual
Prefix:MR
First Name:RENDER
Middle Name:TERRELL
Last Name:PARHAM
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:R TERRELL
Other - Middle Name:
Other - Last Name:PARHAM
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2142 FAIR RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7401
Mailing Address - Country:US
Mailing Address - Phone:770-377-1346
Mailing Address - Fax:770-473-6855
Practice Address - Street 1:180 N LEE ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-2122
Practice Address - Country:US
Practice Address - Phone:478-994-6005
Practice Address - Fax:478-994-6005
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010268183500000X
AL10447183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist