Provider Demographics
NPI:1073116737
Name:FAULK, ANNA LEE (PHARMD, BCGP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LEE
Last Name:FAULK
Suffix:
Gender:F
Credentials:PHARMD, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 DOLLY DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31044-6951
Mailing Address - Country:US
Mailing Address - Phone:478-960-5067
Mailing Address - Fax:
Practice Address - Street 1:342 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-2103
Practice Address - Country:US
Practice Address - Phone:478-783-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0226931835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric