Provider Demographics
NPI:1194009381
Name:KASIANCHUK, ANDREW J (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:KASIANCHUK
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 1:651 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2954
Mailing Address - Country:US
Mailing Address - Phone:219-662-1695
Mailing Address - Fax:
Practice Address - Street 1:651 HARVEST CT
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2954
Practice Address - Country:US
Practice Address - Phone:219-662-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014063A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist