Provider Demographics
NPI:1588949556
Name:ANDERSON, FERNANDA FRANCA (RPH)
Entity type:Individual
Prefix:MRS
First Name:FERNANDA
Middle Name:FRANCA
Last Name:ANDERSON
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 1:3801 SPRINGCREEK DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4854
Mailing Address - Country:US
Mailing Address - Phone:209-527-0573
Mailing Address - Fax:
Practice Address - Street 1:1700 STANDIFORD AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6534
Practice Address - Country:US
Practice Address - Phone:209-527-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38507183500000X
AZ7671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist