Provider Demographics
NPI:1669865853
Name:VELAZQUEZ, ANDRES (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:VELAZQUEZ
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 1:800 COMMERCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-5217
Mailing Address - Country:US
Mailing Address - Phone:209-676-3177
Mailing Address - Fax:209-676-3175
Practice Address - Street 1:800 COMMERCE AVE
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-5217
Practice Address - Country:US
Practice Address - Phone:209-676-3177
Practice Address - Fax:209-676-3175
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist