Provider Demographics
NPI:1982369047
Name:CLAYBERG, ANDREA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CLAYBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 S ARTHUR CT
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1849
Mailing Address - Country:US
Mailing Address - Phone:323-712-2103
Mailing Address - Fax:
Practice Address - Street 1:1901 N STEPTOE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7120
Practice Address - Country:US
Practice Address - Phone:509-783-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61186032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist