Provider Demographics
NPI:1346451226
Name:WILLMAN, ANDREA (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WILLMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 WOODS WEST DR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-9463
Mailing Address - Country:US
Mailing Address - Phone:810-659-2509
Mailing Address - Fax:
Practice Address - Street 1:7020 WOODS WEST DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-9463
Practice Address - Country:US
Practice Address - Phone:810-659-2509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031923183500000X
IN26013436A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist