Healthcare Provider Details

I. General information

NPI: 1154282267
Provider Name (Legal Business Name): ANDREY BUIE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 S FORTUNA BLVD
FORTUNA CA
95540
US

IV. Provider business mailing address

75 DEL VISTA CIR
SACRAMENTO CA
95823-5634
US

V. Phone/Fax

Practice location:
  • Phone: 707-726-0377
  • Fax:
Mailing address:
  • Phone: 916-596-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: