Provider Demographics
NPI:1932200136
Name:SIMENTAL, ANDREW JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:SIMENTAL
Suffix:JR
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 1:7520 SVL BOX
Mailing Address - Street 2:13150 ALTA VISTA
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5157
Mailing Address - Country:US
Mailing Address - Phone:909-427-5026
Mailing Address - Fax:909-427-4365
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:KAISER HOSPITAL BLDG 3, BSMT INPT PHARMACY
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-5026
Practice Address - Fax:909-427-4365
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist