MEDICARE: MS. AUDRA SUE ANDERSON PHARMD

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	0202206678	VA

General Provider Information

NPI Number	:	1730176066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AUDRA SUE ANDERSON PHARMD

Provider Business Mailing Address
First Line	:	614 N BOULEVARD
Second Line	:	APT 3
City	:	RICHMOND
State	:	VA
Zip	:	23220-2638
Country	:	US
Telephone Number	:	804-317-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	7045 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1607
Country	:	US
Telephone Number	:	804-272-2114
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/08/2007

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