Provider Demographics
NPI:1407027642
Name:ANDERSON, AMIE PARKS (RPH)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:PARKS
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 1:115 MELROSE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2351
Mailing Address - Country:US
Mailing Address - Phone:770-507-0325
Mailing Address - Fax:
Practice Address - Street 1:101 FAIRVIEW RD
Practice Address - Street 2:(KROGER PHARMACY)
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-2722
Practice Address - Country:US
Practice Address - Phone:770-389-7088
Practice Address - Fax:770-507-5402
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist