MEDICARE: MS. ANNA HENDERSHOT 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	RPH021003	GA

General Provider Information

NPI Number	:	1700951431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNA HENDERSHOT RPH

Provider Business Mailing Address
First Line	:	PO BOX 7150
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31418-7150
Country	:	US
Telephone Number	:	912-965-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 GULFSTREAM ROAD
Second Line	:
City	:	GARDEN CITY
State	:	GA
Zip	:	31418
Country	:	US
Telephone Number	:	912-965-6232
Fax Number	:	912-965-2751

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	03/19/2008

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