Provider Demographics
NPI:1457645509
Name:LICARI, ANNA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MICHELLE
Last Name:LICARI
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 1:1433 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9713
Mailing Address - Country:US
Mailing Address - Phone:336-712-0663
Mailing Address - Fax:336-712-8290
Practice Address - Street 1:1433 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9713
Practice Address - Country:US
Practice Address - Phone:336-712-0663
Practice Address - Fax:336-712-8290
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist