Healthcare Provider Details

I. General information

NPI: 1477147304
Provider Name (Legal Business Name): ANDREW TRAVIS LUKE PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W OAK ST
MC RAE HELENA GA
31055-4335
US

IV. Provider business mailing address

120 W OAK ST
MC RAE HELENA GA
31055-4335
US

V. Phone/Fax

Practice location:
  • Phone: 229-868-6120
  • Fax: 229-868-6121
Mailing address:
  • Phone: 229-868-6120
  • Fax: 229-868-6121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH025265
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: