Provider Demographics
NPI:1528015724
Name:ULLRICH, ANDRES ARTHUR (RPH)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:ARTHUR
Last Name:ULLRICH
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 1:190 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3212
Mailing Address - Country:US
Mailing Address - Phone:706-549-5876
Mailing Address - Fax:706-353-8134
Practice Address - Street 1:975A HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2139
Practice Address - Country:US
Practice Address - Phone:706-548-5227
Practice Address - Fax:706-353-8134
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist