Provider Demographics
NPI:1669078739
Name:GUNNERSON, ANDREA CHRISTINE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:CHRISTINE
Last Name:GUNNERSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 W 3400 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-7961
Mailing Address - Country:US
Mailing Address - Phone:702-283-8154
Mailing Address - Fax:
Practice Address - Street 1:4949 S 900 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3777
Practice Address - Country:US
Practice Address - Phone:801-612-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT319319-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist