Provider Demographics
NPI:1477147304
Name:LUKE, ANDREW TRAVIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TRAVIS
Last Name:LUKE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:MC RAE HELENA
Mailing Address - State:GA
Mailing Address - Zip Code:31055-4335
Mailing Address - Country:US
Mailing Address - Phone:229-868-6120
Mailing Address - Fax:229-868-6121
Practice Address - Street 1:120 W OAK ST
Practice Address - Street 2:
Practice Address - City:MC RAE HELENA
Practice Address - State:GA
Practice Address - Zip Code:31055-4335
Practice Address - Country:US
Practice Address - Phone:229-868-6120
Practice Address - Fax:229-868-6121
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist