Provider Demographics
NPI:1629674775
Name:BARDALES, ANDREW FELIX (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:FELIX
Last Name:BARDALES
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 1:49 LANDAU AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3603
Mailing Address - Country:US
Mailing Address - Phone:516-491-0585
Mailing Address - Fax:
Practice Address - Street 1:1140 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2073
Practice Address - Country:US
Practice Address - Phone:631-727-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI066889183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist