Provider Demographics
NPI:1386982734
Name:BURRELL, ANN ELDER (RPH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ELDER
Last Name:BURRELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 KINGSTON CIR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9350
Mailing Address - Country:US
Mailing Address - Phone:912-312-5020
Mailing Address - Fax:
Practice Address - Street 1:12800 HWY 144
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-7343
Practice Address - Country:US
Practice Address - Phone:912-459-1177
Practice Address - Fax:912-459-1182
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH014340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist