Provider Demographics
NPI:1114911252
Name:ANDREWS, PHILLIP EDWARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:EDWARD
Last Name:ANDREWS
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 1:2336 BROTHER ABDON WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6926
Mailing Address - Country:US
Mailing Address - Phone:505-984-1137
Mailing Address - Fax:505-471-2172
Practice Address - Street 1:2308 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3264
Practice Address - Country:US
Practice Address - Phone:505-471-7876
Practice Address - Fax:505-471-2172
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00004934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist