Provider Demographics
NPI:1407209695
Name:GAGNON, ANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GAGNON
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 1:324 AUDUBON OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8200
Mailing Address - Country:US
Mailing Address - Phone:803-609-0509
Mailing Address - Fax:
Practice Address - Street 1:6118 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3122
Practice Address - Country:US
Practice Address - Phone:803-798-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist