Provider Demographics
NPI:1538821020
Name:ANDREW S ART OF PHARMACY PLLC
Entity type:Organization
Organization Name:ANDREW S ART OF PHARMACY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:VAN ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-434-6645
Mailing Address - Street 1:PO BOX 4313
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4313
Mailing Address - Country:US
Mailing Address - Phone:601-434-6645
Mailing Address - Fax:
Practice Address - Street 1:310 POPPS FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2349
Practice Address - Country:US
Practice Address - Phone:601-434-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy