Provider Demographics
NPI:1013386267
Name:INTRABOONA, ANNA USAHA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:USAHA
Last Name:INTRABOONA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27954 ALABAMA HIGHWAY 91
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077
Mailing Address - Country:US
Mailing Address - Phone:205-936-3274
Mailing Address - Fax:
Practice Address - Street 1:626 OLIVE ST SW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-5594
Practice Address - Country:US
Practice Address - Phone:256-739-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist