Provider Demographics
NPI:1730176066
Name:ANDERSON, AUDRA SUE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:AUDRA
Middle Name:SUE
Last Name:ANDERSON
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 1:614 N BOULEVARD
Mailing Address - Street 2:APT 3
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-2638
Mailing Address - Country:US
Mailing Address - Phone:804-317-2054
Mailing Address - Fax:
Practice Address - Street 1:7045 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1607
Practice Address - Country:US
Practice Address - Phone:804-272-2114
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist