Provider Demographics
NPI:1770921488
Name:FUNK, ANDREW RYAN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:FUNK
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 1:28410 STUMP HOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:IA
Mailing Address - Zip Code:50003-8756
Mailing Address - Country:US
Mailing Address - Phone:515-306-7752
Mailing Address - Fax:
Practice Address - Street 1:250 SE GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-2045
Practice Address - Country:US
Practice Address - Phone:515-986-0101
Practice Address - Fax:515-986-3382
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist