Provider Demographics
NPI:1275258568
Name:ANDRADE, EMMANUEL ALEJANDRO (PHARMD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ALEJANDRO
Last Name:ANDRADE
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 1:2592 N COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-8709
Mailing Address - Country:US
Mailing Address - Phone:478-454-3426
Mailing Address - Fax:
Practice Address - Street 1:2592 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-8709
Practice Address - Country:US
Practice Address - Phone:478-454-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist