Provider Demographics
NPI:1336350719
Name:VANCLEVE, ANDREW RICHARD (DPH)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:VANCLEVE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 MURPHY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38019-1911
Mailing Address - Country:US
Mailing Address - Phone:901-475-4417
Mailing Address - Fax:901-476-5653
Practice Address - Street 1:951 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-1702
Practice Address - Country:US
Practice Address - Phone:901-476-1798
Practice Address - Fax:901-476-1799
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55861835P1200X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy