Provider Demographics
NPI:1326317033
Name:KINNIBURGH, ANDREA PLATZ (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:PLATZ
Last Name:KINNIBURGH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11293 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-5203
Mailing Address - Country:US
Mailing Address - Phone:662-473-4223
Mailing Address - Fax:
Practice Address - Street 1:329 SUNSET DR
Practice Address - Street 2:
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4505
Practice Address - Country:US
Practice Address - Phone:662-226-6631
Practice Address - Fax:662-226-6650
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist