Provider Demographics
NPI:1164940292
Name:PALELLA, ANDREW DOMINIQUE
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DOMINIQUE
Last Name:PALELLA
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 1:14722 MISTLETOE AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93314-9115
Mailing Address - Country:US
Mailing Address - Phone:610-462-3169
Mailing Address - Fax:
Practice Address - Street 1:3401 MALL VIEW RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3060
Practice Address - Country:US
Practice Address - Phone:661-872-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67649183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist