Provider Demographics
NPI:1801479803
Name:LUNDAHL, ANDREW (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LUNDAHL
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 1:926 S MISSION ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3548
Mailing Address - Country:US
Mailing Address - Phone:989-773-8200
Mailing Address - Fax:989-773-8282
Practice Address - Street 1:926 S MISSION ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3548
Practice Address - Country:US
Practice Address - Phone:989-773-8200
Practice Address - Fax:989-773-8282
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist