Provider Demographics
NPI:1558738138
Name:STORJOHANN, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STORJOHANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S CHERRY ST
Mailing Address - Street 2:#300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 S CHERRY ST
Practice Address - Street 2:#300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1801
Practice Address - Country:US
Practice Address - Phone:303-794-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist