Provider Demographics
NPI:1154043453
Name:SODERBERG, ANNA ROSE (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:SODERBERG
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 1:1017 RIVER HAVEN CIR APT 17W
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-4126
Mailing Address - Country:US
Mailing Address - Phone:785-331-8489
Mailing Address - Fax:
Practice Address - Street 1:1115 OLD TOWNE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6062
Practice Address - Country:US
Practice Address - Phone:843-766-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist