Provider Demographics
NPI:1578810438
Name:ANDRY, JOHN CLETUS III (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLETUS
Last Name:ANDRY
Suffix:III
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2731 MANHATTAN BLVD
Mailing Address - Street 2:SUITE B17
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-6151
Mailing Address - Country:US
Mailing Address - Phone:504-355-4191
Mailing Address - Fax:504-355-4192
Practice Address - Street 1:2731 MANHATTAN BLVD
Practice Address - Street 2:SUITE B17
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-6151
Practice Address - Country:US
Practice Address - Phone:504-355-4191
Practice Address - Fax:504-355-4192
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA191371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist