| NPI | 1295846004 |
|---|---|
| Former Name | DEMETRIA ROCHELLE GAINES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: AL 14913) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: GA RPH022748) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-12-31 |