Provider Demographics
NPI:1821373622
Name:ANDERSON, MARK WINTHROP JR (PHARM D)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WINTHROP
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 KRISTI LYNNS WAY
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4576
Mailing Address - Country:US
Mailing Address - Phone:706-562-9370
Mailing Address - Fax:
Practice Address - Street 1:7869 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-1721
Practice Address - Country:US
Practice Address - Phone:706-571-9312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH020809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist