Provider Demographics
NPI:1780230714
Name:FYNE, ANDREW ANTHONY (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ANTHONY
Last Name:FYNE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MAIN ST UNIT 409
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2309
Mailing Address - Country:US
Mailing Address - Phone:718-710-8432
Mailing Address - Fax:
Practice Address - Street 1:220 ALBANY TPKE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2565
Practice Address - Country:US
Practice Address - Phone:860-693-8329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPTN.0014593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTPCT.0014593Medicaid