Provider Demographics
NPI:1093353682
Name:PLESS, ANDREW JAMES JR (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:PLESS
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015-1539
Mailing Address - Country:US
Mailing Address - Phone:229-273-8231
Mailing Address - Fax:229-273-8273
Practice Address - Street 1:1011 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1539
Practice Address - Country:US
Practice Address - Phone:229-273-8231
Practice Address - Fax:229-273-8273
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-15
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17645183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist