Provider Demographics
NPI:1275749616
Name:COURNOYER, ANDREW J (RPH, MBA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OLD BARGE RD
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-1741
Mailing Address - Country:US
Mailing Address - Phone:860-431-5136
Mailing Address - Fax:
Practice Address - Street 1:55 CAMBRIDGE PKWY
Practice Address - Street 2:SUITE 300E
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1234
Practice Address - Country:US
Practice Address - Phone:617-299-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2015-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist