Provider Demographics
NPI:1184024069
Name:DEICHERT, ANDREW STEWART (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:STEWART
Last Name:DEICHERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 CLEARWATER RD
Mailing Address - Street 2:APPT 338
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-4590
Mailing Address - Country:US
Mailing Address - Phone:701-770-5256
Mailing Address - Fax:
Practice Address - Street 1:2505 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3837
Practice Address - Country:US
Practice Address - Phone:320-251-9433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist