Provider Demographics
NPI:1245621721
Name:RANSOM, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:RANSOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N. BEELINE HWY
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-6228
Mailing Address - Country:US
Mailing Address - Phone:928-474-0034
Mailing Address - Fax:928-474-0036
Practice Address - Street 1:300 N BEELINE HWY
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4305
Practice Address - Country:US
Practice Address - Phone:928-474-0034
Practice Address - Fax:928-474-0036
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZRPH12335OtherPRESCRIBER/DISPENSER DATABASE ACCESS REQUEST