Provider Demographics
NPI:1346841657
Name:MORAITAKIS, ANNA LECKIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:LECKIE
Last Name:MORAITAKIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 HIGHLAND COLONY DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2148
Mailing Address - Country:US
Mailing Address - Phone:404-403-4474
Mailing Address - Fax:
Practice Address - Street 1:3105 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-1013
Practice Address - Country:US
Practice Address - Phone:770-974-5119
Practice Address - Fax:770-974-6029
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist