Provider Demographics
NPI:1174515944
Name:DAMON, ANN ROSSER (PHARMD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ROSSER
Last Name:DAMON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:972 PECAN GROVE PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-5515
Mailing Address - Country:US
Mailing Address - Phone:770-963-1832
Mailing Address - Fax:770-279-6235
Practice Address - Street 1:3945 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2817
Practice Address - Country:US
Practice Address - Phone:770-806-6835
Practice Address - Fax:770-279-6235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014016183500000X
NC06180183500000X
SC004763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist