Provider Demographics
NPI:1295480606
Name:TAKAHATA, ANDY (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:TAKAHATA
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 1:885 N ITHICA CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-3973
Mailing Address - Country:US
Mailing Address - Phone:808-478-7154
Mailing Address - Fax:
Practice Address - Street 1:17250 N HARTFORD DR STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5496
Practice Address - Country:US
Practice Address - Phone:866-453-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist