Provider Demographics
NPI:1629671813
Name:ANASTASIA, ANDREW GREGORY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GREGORY
Last Name:ANASTASIA
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 1:5681 NE GLISAN ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-3463
Mailing Address - Country:US
Mailing Address - Phone:847-533-1669
Mailing Address - Fax:
Practice Address - Street 1:6901 SE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-9721
Practice Address - Country:US
Practice Address - Phone:503-280-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051301445183500000X
OR18210183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist