Provider Demographics
NPI:1992160956
Name:CULLUM, ANDRIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDRIA
Middle Name:
Last Name:CULLUM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANDRIA
Other - Middle Name:
Other - Last Name:ELBL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3906
Mailing Address - Country:US
Mailing Address - Phone:719-275-7511
Mailing Address - Fax:
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3906
Practice Address - Country:US
Practice Address - Phone:719-275-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52424183500000X
MO2007023344183500000X
COPHA.0024375183500000X
IL051292200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist