Provider Demographics
NPI:1770685679
Name:EAGLE, ANDREA EXUM (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:EXUM
Last Name:EAGLE
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 1:6888 RANCH FOREST DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2429
Mailing Address - Country:US
Mailing Address - Phone:706-681-6126
Mailing Address - Fax:
Practice Address - Street 1:1800 TENTH AVE
Practice Address - Street 2:FAMILY HEALTH PHARMACY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-7201
Practice Address - Country:US
Practice Address - Phone:706-571-1995
Practice Address - Fax:706-571-1781
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17303183500000X
GA019185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist