Provider Demographics
NPI:1063655652
Name:BARTELS, ANDREA J (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:J
Last Name:BARTELS
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 1:2020 COFFEE RD STE C2
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2407
Mailing Address - Country:US
Mailing Address - Phone:209-522-3367
Mailing Address - Fax:209-522-3375
Practice Address - Street 1:2020 COFFEE RD STE C2
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2407
Practice Address - Country:US
Practice Address - Phone:209-522-3367
Practice Address - Fax:209-522-3375
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist