Provider Demographics
NPI:1396025425
Name:PULKA, ANDREW MITCHELL (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:MITCHELL
Last Name:PULKA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HOPE RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-3955
Mailing Address - Country:US
Mailing Address - Phone:716-725-9589
Mailing Address - Fax:
Practice Address - Street 1:36 MOOSEHEAD TRL
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953-4108
Practice Address - Country:US
Practice Address - Phone:207-368-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR6074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist