Provider Demographics
NPI:1225258734
Name:ANDREW, CHAD (RPH)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:ANDREW
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 1:4524 CALYX CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5282
Mailing Address - Country:US
Mailing Address - Phone:505-792-9731
Mailing Address - Fax:505-292-7468
Practice Address - Street 1:4700 TRAMWAY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2979
Practice Address - Country:US
Practice Address - Phone:505-292-5888
Practice Address - Fax:505-292-7468
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist