Provider Demographics
NPI:1043939713
Name:ANDREWS, ROBERT LEE JR
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:ANDREWS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 166TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1835
Mailing Address - Country:US
Mailing Address - Phone:773-563-3869
Mailing Address - Fax:
Practice Address - Street 1:1340 W 90TH PLACE APT. 104
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6755
Practice Address - Country:US
Practice Address - Phone:773-563-3869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291698183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist