Provider Demographics
NPI:1164139762
Name:ROBELLO, ANDREW TAVARES (MS, PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:TAVARES
Last Name:ROBELLO
Suffix:
Gender:M
Credentials:MS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:BODEGA
Mailing Address - State:CA
Mailing Address - Zip Code:94922-0176
Mailing Address - Country:US
Mailing Address - Phone:707-327-6125
Mailing Address - Fax:
Practice Address - Street 1:2456 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6425
Practice Address - Country:US
Practice Address - Phone:707-571-5955
Practice Address - Fax:707-571-5951
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH81437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist