Provider Demographics
NPI:1356641393
Name:PARRA, ANDREA TONYA (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:TONYA
Last Name:PARRA
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 1:3727 LINDA VISTA AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4192
Mailing Address - Country:US
Mailing Address - Phone:505-453-4378
Mailing Address - Fax:
Practice Address - Street 1:8100 WYOMING BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1947
Practice Address - Country:US
Practice Address - Phone:505-857-9783
Practice Address - Fax:505-857-9835
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist