Provider Demographics
NPI:1962409441
Name:TRAYNOR, ANDREW PHILLIP (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PHILLIP
Last Name:TRAYNOR
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 1:1207 JEAN MARIE ST
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-3004
Mailing Address - Country:US
Mailing Address - Phone:218-879-6309
Mailing Address - Fax:
Practice Address - Street 1:1110 KIRBY DR
Practice Address - Street 2:215 LIFE SCIENCE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-3003
Practice Address - Country:US
Practice Address - Phone:218-726-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN118007-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist