Provider Demographics
NPI:1144567199
Name:BIONDI, ANDY (RPH)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:BIONDI
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 1:1434 OLNEY ST SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4041
Mailing Address - Country:US
Mailing Address - Phone:360-895-0613
Mailing Address - Fax:
Practice Address - Street 1:1434 OLNEY ST SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4041
Practice Address - Country:US
Practice Address - Phone:360-895-0613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00015323183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist