Provider Demographics
NPI:1437569886
Name:NIETZKE, ANDREA (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NIETZKE
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 1:2383 SELKIRK CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4934
Mailing Address - Country:US
Mailing Address - Phone:248-320-1824
Mailing Address - Fax:
Practice Address - Street 1:3175 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5042
Practice Address - Country:US
Practice Address - Phone:248-853-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist