Provider Demographics
NPI:1568695435
Name:ANDERSON, DAVID ROBERT II
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROBERT
Last Name:ANDERSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1144 TOWNSHIP PKWY
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-9635
Mailing Address - Country:US
Mailing Address - Phone:704-502-3176
Mailing Address - Fax:
Practice Address - Street 1:6750 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6202
Practice Address - Country:US
Practice Address - Phone:704-825-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8812183500000X
NC17020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist