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NPI Code Detail

MEDICARE: MS. LAURIE ANDERSON RPH

MEDICARE: MS. LAURIE 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
1183500000XPharmacistRPH024076GA

General Provider Information

NPI Number : 1679856124
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURIE ANDERSON RPH
Provider Business Mailing Address
First Line : 3273 WILLOW MEADOW LN
Second Line :
City : DOUGLASVILLE
State : GA
Zip : 30135-7915
Country : US
Telephone Number : 817-789-9958
Fax Number : 770-942-9945
Provider Business Practice Location Address
First Line : 794 S PARK ST
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-3826
Country : US
Telephone Number : 770-838-1678
Fax Number : 770-838-9352
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2011
Last Update Date : 09/21/2011

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