Provider Demographics
NPI:1043538739
Name:UPCHURCH, ANITA L (RPH CGP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:RPH CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 WINTHROP LN
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-4583
Mailing Address - Country:US
Mailing Address - Phone:765-438-1608
Mailing Address - Fax:765-455-6954
Practice Address - Street 1:3113 WINTHROP LN
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-4583
Practice Address - Country:US
Practice Address - Phone:765-438-1608
Practice Address - Fax:765-455-6954
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014828A1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric