Provider Demographics
NPI:1346237302
Name:DE CORO, ANDREA JEANNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JEANNE
Last Name:DE CORO
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 1:19311 CORALWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2623
Mailing Address - Country:US
Mailing Address - Phone:714-963-4692
Mailing Address - Fax:
Practice Address - Street 1:300 OCEANGATE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4359
Practice Address - Country:US
Practice Address - Phone:562-983-3293
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 46802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist