Provider Demographics
NPI:1417181140
Name:ALVAREZ, ANDREA MARLENE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MARLENE
Last Name:ALVAREZ
Suffix:
Gender:F
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 1:17750 POLARA WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-9186
Mailing Address - Country:US
Mailing Address - Phone:208-467-9455
Mailing Address - Fax:
Practice Address - Street 1:2400 12TH AVE RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-6300
Practice Address - Country:US
Practice Address - Phone:208-463-2903
Practice Address - Fax:208-468-0215
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist