Provider Demographics
NPI:1083928675
Name:THORNDYKE, ANDREW FORMAN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:FORMAN
Last Name:THORNDYKE
Suffix:
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 1:853 N SANDPIPER CLUB DR SW
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-5807
Mailing Address - Country:US
Mailing Address - Phone:910-575-4925
Mailing Address - Fax:
Practice Address - Street 1:852 SUNSET BLVD N
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4262
Practice Address - Country:US
Practice Address - Phone:910-579-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05967183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist