Healthcare Provider Details

I. General information

NPI: 1104588508
Provider Name (Legal Business Name): ANDREW HOFFMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 DAYTON SPRINGFIELD RD
FAIRBORN OH
45324-3560
US

IV. Provider business mailing address

7617 DAYTON SPRINGFIELD RD
FAIRBORN OH
45324-3560
US

V. Phone/Fax

Practice location:
  • Phone: 937-863-0045
  • Fax: 937-863-0050
Mailing address:
  • Phone: 937-831-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03135668
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: