Provider Demographics
NPI:1083190904
Name:CHRISTENSEN, ANDREA ROSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 PROVINCIAL CIR UNIT C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3454
Mailing Address - Country:US
Mailing Address - Phone:864-316-5475
Mailing Address - Fax:
Practice Address - Street 1:1909 N HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7459
Practice Address - Country:US
Practice Address - Phone:843-881-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist