Provider Demographics
NPI:1225308240
Name:ANDERSON, ANDREW ALAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ALAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 BRIGHTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-4706
Mailing Address - Country:US
Mailing Address - Phone:740-452-3691
Mailing Address - Fax:740-452-3162
Practice Address - Street 1:406 BRIGHTON BLVD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-4706
Practice Address - Country:US
Practice Address - Phone:740-452-3691
Practice Address - Fax:740-452-3162
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0010645183500000X
OH03129746-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist