Provider Demographics
NPI:1568588515
Name:DO, ANDY KHOA
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:KHOA
Last Name:DO
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 1:1456 CRYSTALLINE DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-8902
Mailing Address - Country:US
Mailing Address - Phone:616-656-9602
Mailing Address - Fax:
Practice Address - Street 1:5995 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6464
Practice Address - Country:US
Practice Address - Phone:616-827-9906
Practice Address - Fax:616-827-1013
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist