Provider Demographics
NPI:1164791018
Name:ANDERSON, ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 WOODWARD CROSSING BLVD
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4938
Mailing Address - Country:US
Mailing Address - Phone:678-482-6528
Mailing Address - Fax:
Practice Address - Street 1:3205 WOODWARD CROSSING BLVD
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4938
Practice Address - Country:US
Practice Address - Phone:678-482-6528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020605183500000X
WI12953-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist