Provider Demographics
NPI:1962002329
Name:STEWART, ANDREA DAWN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:STEWART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 W 100 S
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-9799
Mailing Address - Country:US
Mailing Address - Phone:317-850-2671
Mailing Address - Fax:
Practice Address - Street 1:4837 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3533
Practice Address - Country:US
Practice Address - Phone:317-830-4259
Practice Address - Fax:317-830-4103
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020925A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist