Provider Demographics
NPI:1467784199
Name:MCANDREWS, MARYBETH (RPH)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MCANDREWS
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 1:5129 BLACK HAWK CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5427
Mailing Address - Country:US
Mailing Address - Phone:315-451-3921
Mailing Address - Fax:
Practice Address - Street 1:4202 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1936
Practice Address - Country:US
Practice Address - Phone:315-487-0326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist