Provider Demographics
NPI:1003124785
Name:BADKE, ANDREA V (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:V
Last Name:BADKE
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 1:18271 COUNTY ROAD 2
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:IN
Mailing Address - Zip Code:46507-9773
Mailing Address - Country:US
Mailing Address - Phone:574-848-7199
Mailing Address - Fax:
Practice Address - Street 1:18271 COUNTY ROAD 2
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IN
Practice Address - Zip Code:46507-9773
Practice Address - Country:US
Practice Address - Phone:574-848-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26013404A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist