Provider Demographics
NPI:1730473950
Name:ANDIA-NAYLOR, LUCY YELKA
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:YELKA
Last Name:ANDIA-NAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:YELKA
Other - Last Name:ANDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5950 STATE BRIDGE RD
Mailing Address - Street 2:T-0749
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6438
Mailing Address - Country:US
Mailing Address - Phone:678-258-1000
Mailing Address - Fax:
Practice Address - Street 1:5950 STATE BRIDGE RD
Practice Address - Street 2:T-0749
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-6438
Practice Address - Country:US
Practice Address - Phone:678-258-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist