MEDICARE: AMIE PARKS ANDERSON RPH

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	RPH017279	GA

General Provider Information

NPI Number	:	1407027642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIE PARKS ANDERSON RPH

Provider Business Mailing Address
First Line	:	115 MELROSE CREEK DR
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-2351
Country	:	US
Telephone Number	:	770-507-0325
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 FAIRVIEW RD
Second Line	:	(KROGER PHARMACY)
City	:	ELLENWOOD
State	:	GA
Zip	:	30294-2722
Country	:	US
Telephone Number	:	770-389-7088
Fax Number	:	770-507-5402

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

Provider Enumeration Date	:	03/16/2008
Last Update Date	:	03/16/2008

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