Provider Demographics
NPI:1083214472
Name:SAPPENFIELD, ANDREA JEAN
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:SAPPENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MACLAREN CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-6956
Mailing Address - Country:US
Mailing Address - Phone:317-474-0028
Mailing Address - Fax:
Practice Address - Street 1:2125 N MORTON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9624
Practice Address - Country:US
Practice Address - Phone:317-738-4387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017209A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist