Provider Demographics
NPI:1215453030
Name:DEMOFONTE, ANDREW (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:DEMOFONTE
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 1:10595 N MICHIGAN RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9685
Mailing Address - Country:US
Mailing Address - Phone:317-872-5498
Mailing Address - Fax:
Practice Address - Street 1:10595 N MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9685
Practice Address - Country:US
Practice Address - Phone:317-872-5498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027284A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist