Provider Demographics
NPI:1447402698
Name:ANDERSON, JAMES HAROLD (DPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HAROLD
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-8028
Mailing Address - Country:US
Mailing Address - Phone:662-240-1260
Mailing Address - Fax:662-244-1177
Practice Address - Street 1:235 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-8028
Practice Address - Country:US
Practice Address - Phone:662-240-1260
Practice Address - Fax:662-244-1177
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST8445183500000X
TNC8778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist