Provider Demographics
NPI:1396793642
Name:ANDERSON, ROBERT J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2035 MCELROY MOUNTAIN DRIVE
Mailing Address - Street 2:11244 BIG CANOE
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143
Mailing Address - Country:US
Mailing Address - Phone:706-579-1708
Mailing Address - Fax:
Practice Address - Street 1:245 GILMER FERRY RD
Practice Address - Street 2:
Practice Address - City:BALL GROUND
Practice Address - State:GA
Practice Address - Zip Code:30107-2908
Practice Address - Country:US
Practice Address - Phone:770-735-6161
Practice Address - Fax:770-735-6925
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0148921835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy