Provider Demographics
NPI:1093933798
Name:FAILLA, ANDREW L (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:L
Last Name:FAILLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-0010
Mailing Address - Country:US
Mailing Address - Phone:601-798-4846
Mailing Address - Fax:601-798-4825
Practice Address - Street 1:110 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3312
Practice Address - Country:US
Practice Address - Phone:601-798-4846
Practice Address - Fax:601-798-4825
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-07894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist