Provider Demographics
NPI:1710184320
Name:ANDA, PETER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ANDA
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 1:8904 W MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1631
Mailing Address - Country:US
Mailing Address - Phone:509-545-5779
Mailing Address - Fax:509-943-2201
Practice Address - Street 1:1320 LEE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4105
Practice Address - Country:US
Practice Address - Phone:509-946-0656
Practice Address - Fax:509-943-2201
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00056148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist