Provider Demographics
NPI:1942619499
Name:ARMINO-EWEN, ANDREA KATHERINE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHERINE
Last Name:ARMINO-EWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KATHERINE
Other - Last Name:EWEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:712 E BAY AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3447
Mailing Address - Country:US
Mailing Address - Phone:609-994-3588
Mailing Address - Fax:609-994-3706
Practice Address - Street 1:712 E BAY AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3447
Practice Address - Country:US
Practice Address - Phone:609-994-3588
Practice Address - Fax:609-994-3706
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02355100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7420820001Medicare NSC