Provider Demographics
NPI:1124572854
Name:HAZIPETROS, ANDROS FRAILEY
Entity Type:Individual
Prefix:
First Name:ANDROS
Middle Name:FRAILEY
Last Name:HAZIPETROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3943
Mailing Address - Country:US
Mailing Address - Phone:717-490-0848
Mailing Address - Fax:
Practice Address - Street 1:2000 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-3814
Practice Address - Country:US
Practice Address - Phone:215-567-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist