Provider Demographics
NPI:1386010197
Name:KINCHAK, ANDREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREY
Middle Name:
Last Name:KINCHAK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-5587
Mailing Address - Country:US
Mailing Address - Phone:916-727-2458
Mailing Address - Fax:916-727-2460
Practice Address - Street 1:7301 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-5587
Practice Address - Country:US
Practice Address - Phone:916-727-2458
Practice Address - Fax:916-727-2460
Is Sole Proprietor?:No
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72917183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist