Provider Demographics
NPI:1326517491
Name:ANDRESEN, ROBERT CHARLES (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:ANDRESEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8438 SHOREWAY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2435
Mailing Address - Country:US
Mailing Address - Phone:812-786-9131
Mailing Address - Fax:
Practice Address - Street 1:8438 SHOREWAY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2435
Practice Address - Country:US
Practice Address - Phone:812-786-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH3212183500000X
IN26012747A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist