Provider Demographics
NPI:1013734623
Name:ANDREICA, IVYRUTH W (PHARMD, FISMP)
Entity type:Individual
Prefix:
First Name:IVYRUTH
Middle Name:W
Last Name:ANDREICA
Suffix:
Gender:F
Credentials:PHARMD, FISMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-0148
Mailing Address - Country:US
Mailing Address - Phone:603-349-8936
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 148
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-0148
Practice Address - Country:US
Practice Address - Phone:603-349-8936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH234417183500000X
NH3765183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist