Provider Demographics
NPI:1104035708
Name:DIFALCO, ANDREA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:DIFALCO
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 1:1000 SOMMERSWORTH LN
Mailing Address - Street 2:APT #1538
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1188
Mailing Address - Country:US
Mailing Address - Phone:304-668-0769
Mailing Address - Fax:
Practice Address - Street 1:2001 MAYWILL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3236
Practice Address - Country:US
Practice Address - Phone:804-340-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist