Provider Demographics
NPI:1215486881
Name:DE NIESE, ANDREW CHRISTOPHER (RPH)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:DE NIESE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S DOHENY DR
Mailing Address - Street 2:APT 809
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2955
Mailing Address - Country:US
Mailing Address - Phone:646-226-4523
Mailing Address - Fax:
Practice Address - Street 1:100 S DOHENY DR
Practice Address - Street 2:APT 809
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-2955
Practice Address - Country:US
Practice Address - Phone:646-226-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH59221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist