Provider Demographics
NPI:1124391172
Name:LIVINGSTON, ANDREA S (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:S
Last Name:LIVINGSTON
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 1:560 W KATHLEEN AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8392
Mailing Address - Country:US
Mailing Address - Phone:208-665-4733
Mailing Address - Fax:208-665-4727
Practice Address - Street 1:560 W KATHLEEN AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8392
Practice Address - Country:US
Practice Address - Phone:208-665-4733
Practice Address - Fax:208-665-4727
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP6033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist