Provider Demographics
NPI:1245578368
Name:FETTERMAN, ANDRIA
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:FETTERMAN
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 1:5500 ABERCORN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6913
Mailing Address - Country:US
Mailing Address - Phone:912-659-6190
Mailing Address - Fax:
Practice Address - Street 1:5500 ABERCORN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6913
Practice Address - Country:US
Practice Address - Phone:912-353-1266
Practice Address - Fax:912-353-1273
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA024531OtherSTATE PHARMACIST LISCENSE NUMBER