Provider Demographics
NPI:1114539103
Name:PEASE, ANDREA ROSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ROSE
Last Name:PEASE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARTBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37887-4199
Mailing Address - Country:US
Mailing Address - Phone:350-542-3346
Mailing Address - Fax:423-346-5101
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARTBURG
Practice Address - State:TN
Practice Address - Zip Code:37887-4199
Practice Address - Country:US
Practice Address - Phone:350-542-3346
Practice Address - Fax:423-346-5101
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist