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NPI Code Detail

MEDICARE: ANA DATES PHARM.D.

MEDICARE: ANA DATES PHARM.D.
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
1183500000XPharmacist20811NC

General Provider Information

NPI Number : 1861776668
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANA DATES PHARM.D.
Provider Business Mailing Address
First Line : 3300 RAMSEY ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-7624
Country : US
Telephone Number : 910-822-4965
Fax Number :
Provider Business Practice Location Address
First Line : 3300 RAMSEY ST
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28301-7624
Country : US
Telephone Number : 910-822-4965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2011
Last Update Date : 09/29/2011

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