Provider Demographics
NPI:1457821506
Name:ANDELIJA, ALMEDIN (RPH)
Entity Type:Individual
Prefix:
First Name:ALMEDIN
Middle Name:
Last Name:ANDELIJA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-3751
Mailing Address - Country:US
Mailing Address - Phone:315-235-0204
Mailing Address - Fax:315-235-0214
Practice Address - Street 1:1122 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-3751
Practice Address - Country:US
Practice Address - Phone:315-235-0204
Practice Address - Fax:315-235-0214
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061736-I183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist