Provider Demographics
NPI:1134525744
Name:HOMAN, ANDREA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HOMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HIGHWAY 33 S
Mailing Address - Street 2:SUITE 12
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:707 HIGHWAY 33 S
Practice Address - Street 2:SUITE 12
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2696
Practice Address - Country:US
Practice Address - Phone:218-879-6768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist