Provider Demographics
NPI:1891890943
Name:ANDRUS, MICHAEL Q (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Q
Last Name:ANDRUS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 S 1380 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-5380
Mailing Address - Country:US
Mailing Address - Phone:801-582-9709
Mailing Address - Fax:
Practice Address - Street 1:LDS OUTPATIENT PHARMACY
Practice Address - Street 2:8TH AVE AND C STREET
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-1298
Practice Address - Fax:701-408-5172
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5256322-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist