Provider Demographics
NPI:1083221410
Name:BUDGEWATER, ANDRE D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:D
Last Name:BUDGEWATER
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 1:2228 ISLAND BYU
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-2207
Mailing Address - Country:US
Mailing Address - Phone:903-583-2887
Mailing Address - Fax:903-583-2122
Practice Address - Street 1:2228 ISLAND BYU
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2207
Practice Address - Country:US
Practice Address - Phone:903-583-2887
Practice Address - Fax:903-583-2122
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist