Provider Demographics
NPI:1649554619
Name:ANDRE, KETLIE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KETLIE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N CONGRESS AVE APT A405
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1667
Mailing Address - Country:US
Mailing Address - Phone:561-688-9930
Mailing Address - Fax:
Practice Address - Street 1:2501 BROADWAY
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4534
Practice Address - Country:US
Practice Address - Phone:561-848-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist