Provider Demographics
NPI:1457565368
Name:PIETERSE, ANDRIES JACOBUS (RPH CDM)
Entity Type:Individual
Prefix:MR
First Name:ANDRIES
Middle Name:JACOBUS
Last Name:PIETERSE
Suffix:
Gender:M
Credentials:RPH CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41000 CALIFORNIA OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5749
Mailing Address - Country:US
Mailing Address - Phone:951-600-1127
Mailing Address - Fax:951-600-1138
Practice Address - Street 1:41000 CALIFORNIA OAKS RD
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5749
Practice Address - Country:US
Practice Address - Phone:951-600-1127
Practice Address - Fax:951-600-1138
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH53374183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist