Provider Demographics
NPI:1063730935
Name:KEATON BILICKI, ANNE K (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:K
Last Name:KEATON BILICKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:H
Other - Last Name:KEATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2005 MAPLE ST SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6783
Mailing Address - Country:US
Mailing Address - Phone:706-234-5392
Mailing Address - Fax:
Practice Address - Street 1:2005 MAPLE ST SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6783
Practice Address - Country:US
Practice Address - Phone:706-234-5392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3677183500000X
GARPH025866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist