Provider Demographics
NPI:1376043125
Name:ANDERSON, THERNELL ROTHCHILD IV (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:THERNELL
Middle Name:ROTHCHILD
Last Name:ANDERSON
Suffix:IV
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILLTOP DR APT 27
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2816
Mailing Address - Country:US
Mailing Address - Phone:317-306-5293
Mailing Address - Fax:
Practice Address - Street 1:980 E CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1002
Practice Address - Country:US
Practice Address - Phone:530-221-5028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA78015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist