Provider Demographics
NPI:1902173909
Name:BALLESTER, ANDREW SCOTT (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:BALLESTER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1658
Mailing Address - Country:US
Mailing Address - Phone:714-612-9899
Mailing Address - Fax:714-525-7997
Practice Address - Street 1:610 E. HERMOSA DR
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-612-9899
Practice Address - Fax:714-525-7997
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist