MEDICARE: DR. LAURA KAY ANDERSON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH023131	GA

General Provider Information

NPI Number	:	1063797405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA KAY ANDERSON PHARMD

Provider Business Mailing Address
First Line	:	580 KRISTI LYNNS WAY
Second Line	:
City	:	MIDLAND
State	:	GA
Zip	:	31820-4576
Country	:	US
Telephone Number	:	706-577-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 WYNNTON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2184
Country	:	US
Telephone Number	:	706-327-6181
Fax Number	:	706-327-7471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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