Provider Demographics
NPI:1255672101
Name:TATE, ANDREW RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:TATE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9708
Mailing Address - Country:US
Mailing Address - Phone:785-260-4718
Mailing Address - Fax:
Practice Address - Street 1:2010 BECKER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-1620
Practice Address - Country:US
Practice Address - Phone:785-864-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist