Provider Demographics
NPI:1639302094
Name:ANDRADE, OSCAR A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:A
Last Name:ANDRADE
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 1:3645 MIDNIGHT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1663
Mailing Address - Country:US
Mailing Address - Phone:575-993-1273
Mailing Address - Fax:575-541-8561
Practice Address - Street 1:1256 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6026
Practice Address - Country:US
Practice Address - Phone:575-525-8713
Practice Address - Fax:575-541-8561
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist