Provider Demographics
NPI:1114157872
Name:D'AMICO, ANNA GRACE
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:GRACE
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 MICHIGAN AVE E
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-6292
Mailing Address - Country:US
Mailing Address - Phone:269-660-9509
Mailing Address - Fax:269-660-9074
Practice Address - Street 1:890 MICHIGAN AVE E
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-6292
Practice Address - Country:US
Practice Address - Phone:269-660-9509
Practice Address - Fax:269-660-9074
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist