Healthcare Provider Details

I. General information

NPI: 1730427535
Provider Name (Legal Business Name): ANDREW R BERNARD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 70 BOX 30 #2014-1 PHS HOUSING; 1 MI. N. ON NAVAJO RT-16
TONALEA AZ
86044
US

IV. Provider business mailing address

HC 70 BOX 30 #2014-1 PHS HOUSING; 1 MILE NORTH ON NAVAJO RT-16
TONALEA AZ
86044-9610
US

V. Phone/Fax

Practice location:
  • Phone: 928-209-6427
  • Fax: 928-672-3005
Mailing address:
  • Phone: 928-209-6427
  • Fax: 928-672-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35967
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: