Provider Demographics
NPI:1861481772
Name:DRNJEVICH, ANDREW R (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:DRNJEVICH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2741
Mailing Address - Country:US
Mailing Address - Phone:330-296-8508
Mailing Address - Fax:330-296-5284
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2741
Practice Address - Country:US
Practice Address - Phone:330-296-8508
Practice Address - Fax:330-296-5284
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870473Medicaid
OH0870473Medicaid
OH0683080001Medicare NSC