Provider Demographics
NPI:1497034979
Name:CAROLAN, ANDREA JEAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JEAN
Last Name:CAROLAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:JEAN
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:356 GULICK DR APT C
Mailing Address - Street 2:
Mailing Address - City:FORT MONROE
Mailing Address - State:VA
Mailing Address - Zip Code:23651-1333
Mailing Address - Country:US
Mailing Address - Phone:803-629-7460
Mailing Address - Fax:
Practice Address - Street 1:5601 RICHMOND RD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1995
Practice Address - Country:US
Practice Address - Phone:757-565-6407
Practice Address - Fax:757-565-6443
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist