Provider Demographics
NPI:1679868566
Name:DWORK, ANDREA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:DWORK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:HOLLISTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2705 TELLER RD
Mailing Address - Street 2:T-1100
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-1190
Mailing Address - Country:US
Mailing Address - Phone:805-716-1040
Mailing Address - Fax:805-716-1040
Practice Address - Street 1:2705 TELLER RD
Practice Address - Street 2:T-1100
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-1190
Practice Address - Country:US
Practice Address - Phone:805-716-1040
Practice Address - Fax:805-716-1040
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist