Provider Demographics
NPI:1699331116
Name:MYERS, ANDREW
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 GALAHAD CT
Mailing Address - Street 2:
Mailing Address - City:MANTUA
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-2266
Mailing Address - Country:US
Mailing Address - Phone:856-430-8622
Mailing Address - Fax:
Practice Address - Street 1:514 GALAHAD CT
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:NJ
Practice Address - Zip Code:08051-2266
Practice Address - Country:US
Practice Address - Phone:856-430-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041486R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP041486ROtherPHARMACIST LICENSE