Provider Demographics
NPI:1902378870
Name:GONSKA, ANDREW (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:GONSKA
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 1:20 SOOJIAN DR
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01524-1946
Mailing Address - Country:US
Mailing Address - Phone:508-892-4058
Mailing Address - Fax:
Practice Address - Street 1:20 SOOJIAN DR
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:MA
Practice Address - Zip Code:01524-1946
Practice Address - Country:US
Practice Address - Phone:508-892-4058
Practice Address - Fax:508-892-4073
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH232622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0408255Medicaid