Healthcare Provider Details

I. General information

NPI: 1235687815
Provider Name (Legal Business Name): ANDREW JOHN JOSE III PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26322 TOWNE CENTRE DR APT 1123
FOOTHILL RANCH CA
92610-3404
US

IV. Provider business mailing address

26322 TOWNE CENTRE DR APT 1123
FOOTHILL RANCH CA
92610-3404
US

V. Phone/Fax

Practice location:
  • Phone: 949-351-2460
  • Fax:
Mailing address:
  • Phone: 949-351-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number062273
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: