Provider Demographics
NPI:1619275229
Name:BRONAUGH, ANN KATHRYN (RPH)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHRYN
Last Name:BRONAUGH
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 1:3735 HUNTING RIDGE DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2509
Mailing Address - Country:US
Mailing Address - Phone:770-972-4455
Mailing Address - Fax:
Practice Address - Street 1:3295 HWY 124
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6113
Practice Address - Country:US
Practice Address - Phone:770-972-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-06
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist