Provider Demographics
NPI:1013266642
Name:HIBBERT, ANDRAYA JOHNSON (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDRAYA
Middle Name:JOHNSON
Last Name:HIBBERT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 PIEDMONT AVE NE STE 100A
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4816
Mailing Address - Country:US
Mailing Address - Phone:770-401-0222
Mailing Address - Fax:
Practice Address - Street 1:1874 PIEDMONT AVE NE STE 100A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4816
Practice Address - Country:US
Practice Address - Phone:404-733-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist