Provider Demographics
NPI:1164692596
Name:HARPER, ANDREW ALLEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALLEN
Last Name:HARPER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3120
Mailing Address - Country:US
Mailing Address - Phone:951-520-0099
Mailing Address - Fax:951-520-0003
Practice Address - Street 1:770 MAGNOLIA AVE
Practice Address - Street 2:SUITE 1G
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3120
Practice Address - Country:US
Practice Address - Phone:951-520-0099
Practice Address - Fax:951-520-0003
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56860183500000X
VA0202206572183500000X
CAPHY482013336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5742770001Medicare NSC