Provider Demographics
NPI:1427438159
Name:TEDDER, ANDREA TARYN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:TARYN
Last Name:TEDDER
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 1:505 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4815
Mailing Address - Country:US
Mailing Address - Phone:501-328-3117
Mailing Address - Fax:501-327-5194
Practice Address - Street 1:505 SALEM RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-4815
Practice Address - Country:US
Practice Address - Phone:501-328-3117
Practice Address - Fax:501-328-5194
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD13060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist