Provider Demographics
NPI:1457746976
Name:PROFFITT, ANDREA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PROFFITT
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-5105
Mailing Address - Country:US
Mailing Address - Phone:334-494-2768
Mailing Address - Fax:
Practice Address - Street 1:2940 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1152
Practice Address - Country:US
Practice Address - Phone:334-677-6149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10477390200000X
AL19628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program