MEDICARE: ANDRE B HARNANTO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH57266	CA

General Provider Information

NPI Number	:	1881794246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE B HARNANTO PHARMD

Provider Business Mailing Address
First Line	:	2523 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104
Country	:	US
Telephone Number	:	626-791-7600
Fax Number	:	626-791-9165

Provider Business Practice Location Address
First Line	:	2523 E WASHINGTON BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104
Country	:	US
Telephone Number	:	626-791-7600
Fax Number	:	626-791-9165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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