Provider Demographics
NPI:1033473137
Name:CANADA, ANDREW THORNTON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:THORNTON
Last Name:CANADA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 CARRINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:EFLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27243
Mailing Address - Country:US
Mailing Address - Phone:919-304-4278
Mailing Address - Fax:919-304-4405
Practice Address - Street 1:4024 CARRINGTON LN
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-9624
Practice Address - Country:US
Practice Address - Phone:919-304-4278
Practice Address - Fax:919-304-4405
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist