MEDICARE: DONNA ANNE OFFENHAUER 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	RPH016547	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RPH016547	OTHER	GA	STATE LICENSE

General Provider Information

NPI Number	:	1861739724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA ANNE OFFENHAUER PHARMD

Provider Business Mailing Address
First Line	:	1515 RIVER PL
Second Line	:	SUITE 180
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:	770-848-6337
Fax Number	:	770-848-6338

Provider Business Practice Location Address
First Line	:	1515 RIVER PL
Second Line	:	SUITE 180
City	:	BRASELTON
State	:	GA
Zip	:	30517-5602
Country	:	US
Telephone Number	:	770-848-6337
Fax Number	:	770-848-6338

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

Provider Enumeration Date	:	01/12/2013
Last Update Date	:	01/17/2017

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