Healthcare Provider Details

I. General information

NPI: 1174515944
Provider Name (Legal Business Name): ANN ROSSER DAMON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 LAWRENCEVILLE HWY NW
LILBURN GA
30047-2817
US

IV. Provider business mailing address

972 PECAN GROVE PL
LAWRENCEVILLE GA
30045-5515
US

V. Phone/Fax

Practice location:
  • Phone: 770-806-6835
  • Fax: 770-279-6235
Mailing address:
  • Phone: 770-963-1832
  • Fax: 770-279-6235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number014016
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06180
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number004763
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: