Provider Demographics
NPI:1710662978
Name:ANDROK SERVICES, PLLC
Entity Type:Organization
Organization Name:ANDROK SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:ANDREACCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:FPMHNP
Authorized Official - Phone:601-917-1506
Mailing Address - Street 1:3776 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MS
Mailing Address - Zip Code:39335-9426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3776 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:LAUDERDALE
Practice Address - State:MS
Practice Address - Zip Code:39335-9426
Practice Address - Country:US
Practice Address - Phone:601-917-1506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable