Provider Demographics
NPI:1629401393
Name:NYE, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:NYE
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 1:16 HOLLY CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1920
Mailing Address - Country:US
Mailing Address - Phone:856-506-1836
Mailing Address - Fax:
Practice Address - Street 1:5000 PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-1428
Practice Address - Country:US
Practice Address - Phone:609-522-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03562800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist