Provider Demographics
NPI:1568709293
Name:BERRY, ANDREW JOSEPH (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOSEPH
Last Name:BERRY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11202 N 27TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-2563
Mailing Address - Country:US
Mailing Address - Phone:602-478-4946
Mailing Address - Fax:602-839-6742
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:DEPARTMENT OF PHARMACY SERVICES
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-839-2297
Practice Address - Fax:602-839-6742
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZRPH019492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist