Healthcare Provider Details

I. General information

NPI: 1669865853
Provider Name (Legal Business Name): ANDRES VELAZQUEZ PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 COMMERCE AVE
ATWATER CA
95301-5217
US

IV. Provider business mailing address

800 COMMERCE AVE
ATWATER CA
95301-5217
US

V. Phone/Fax

Practice location:
  • Phone: 209-676-3177
  • Fax: 209-676-3175
Mailing address:
  • Phone: 209-676-3177
  • Fax: 209-676-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66643
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: