Provider Demographics
NPI:1619456381
Name:ANDERSON, ANDREW S (PHARMD, RPH, AAHIVP)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHARMD, RPH, AAHIVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LEMMON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2396
Mailing Address - Country:US
Mailing Address - Phone:469-749-7824
Mailing Address - Fax:469-749-7825
Practice Address - Street 1:2801 LEMMON AVE STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2396
Practice Address - Country:US
Practice Address - Phone:469-749-7824
Practice Address - Fax:469-749-7825
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03337383183500000X
TX64702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist