Provider Demographics
NPI:1285239285
Name:BRANCO, ANDREA (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BRANCO
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 1:350 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-3309
Mailing Address - Country:US
Mailing Address - Phone:856-307-0060
Mailing Address - Fax:856-307-0037
Practice Address - Street 1:350 BUCK RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3309
Practice Address - Country:US
Practice Address - Phone:856-307-0060
Practice Address - Fax:856-307-0037
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03027300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist