Provider Demographics
NPI:1790820769
Name:HULCE, ANDREW R
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:HULCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 LYNDEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-6614
Mailing Address - Country:US
Mailing Address - Phone:616-566-8227
Mailing Address - Fax:616-392-8675
Practice Address - Street 1:1104 LYNDEN RD.
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6614
Practice Address - Country:US
Practice Address - Phone:616-566-8227
Practice Address - Fax:616-392-8675
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist