Provider Demographics
NPI:1629689567
Name:KABA, ANDREA MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:KABA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1603
Mailing Address - Country:US
Mailing Address - Phone:718-256-1761
Mailing Address - Fax:718-256-6851
Practice Address - Street 1:7009 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1603
Practice Address - Country:US
Practice Address - Phone:718-256-1761
Practice Address - Fax:718-256-6851
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI06592501183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist