Provider Demographics
NPI:1942970967
Name:STRAUB, ANDREA ROSE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ROSE
Last Name:STRAUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-8226
Mailing Address - Country:US
Mailing Address - Phone:814-882-5155
Mailing Address - Fax:
Practice Address - Street 1:2067 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-8315
Practice Address - Country:US
Practice Address - Phone:814-868-7923
Practice Address - Fax:814-864-3698
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI000668OtherAUTHORIZATION TO ADMINISTER INJECTABLES FOR PHARMACIST