Provider Demographics
NPI:1952927626
Name:DODGE, ANDREW MICHEAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MICHEAL
Last Name:DODGE
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 1:865 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:IN
Mailing Address - Zip Code:47978-3055
Mailing Address - Country:US
Mailing Address - Phone:219-886-4156
Mailing Address - Fax:
Practice Address - Street 1:865 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3055
Practice Address - Country:US
Practice Address - Phone:219-886-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-18
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027791A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist