MEDICARE: EVAN DARWIN ANDERSON

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	RPH025602	GA

General Provider Information

NPI Number	:	1063804094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVAN DARWIN ANDERSON

Provider Business Mailing Address
First Line	:	1740 MEMORIAL DR
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-1044
Country	:	US
Telephone Number	:	912-338-9127
Fax Number	:	912-338-9847

Provider Business Practice Location Address
First Line	:	1740 MEMORIAL DR
Second Line	:
City	:	WAYCROSS
State	:	GA
Zip	:	31501-1044
Country	:	US
Telephone Number	:	912-338-9127
Fax Number	:	912-338-9847

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

Provider Enumeration Date	:	02/27/2015
Last Update Date	:	02/27/2015

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Directions to “ EVAN DARWIN ANDERSON ” Practice Location

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