Provider Demographics
NPI:1790271930
Name:GIRVAN, ANDREA CLARK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CLARK
Last Name:GIRVAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2201
Mailing Address - Country:US
Mailing Address - Phone:207-764-6935
Mailing Address - Fax:207-764-7061
Practice Address - Street 1:781 MAIN ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2201
Practice Address - Country:US
Practice Address - Phone:207-764-6935
Practice Address - Fax:207-764-7061
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty