1578810438 NPI number — DR. JOHN CLETUS ANDRY III PHARM. D.

Table of content: DR. JOHN CLETUS ANDRY III PHARM. D. (NPI 1578810438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578810438 NPI number — DR. JOHN CLETUS ANDRY III PHARM. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDRY
Provider First Name:
JOHN
Provider Middle Name:
CLETUS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
PHARM. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578810438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2731 MANHATTAN BLVD
Provider Second Line Business Mailing Address:
SUITE B17
Provider Business Mailing Address City Name:
HARVEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70058-6151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-355-4191
Provider Business Mailing Address Fax Number:
504-355-4192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2731 MANHATTAN BLVD
Provider Second Line Business Practice Location Address:
SUITE B17
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058-6151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-355-4191
Provider Business Practice Location Address Fax Number:
504-355-4192
Provider Enumeration Date:
08/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  19137 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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