Provider Demographics
NPI:1760781264
Name:ANDERSON, LONI MICHELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:LONI
Middle Name:MICHELLE
Last Name:ANDERSON
Suffix:
Gender:F
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 1:310 GLADES RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1355
Mailing Address - Country:US
Mailing Address - Phone:859-986-3103
Mailing Address - Fax:859-986-4163
Practice Address - Street 1:310 GLADES RD
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1355
Practice Address - Country:US
Practice Address - Phone:859-986-3103
Practice Address - Fax:859-986-4163
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist