Provider Demographics
NPI:1588944029
Name:TITKEMEIER, ANDREW LARRY (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LARRY
Last Name:TITKEMEIER
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 1:7643 PONDEROSA RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-4862
Mailing Address - Country:US
Mailing Address - Phone:419-661-2200
Mailing Address - Fax:800-544-0126
Practice Address - Street 1:7643 PONDEROSA RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-4862
Practice Address - Country:US
Practice Address - Phone:419-661-2200
Practice Address - Fax:800-544-0126
Is Sole Proprietor?:No
Enumeration Date:2011-08-27
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03325783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist