Healthcare Provider Details

I. General information

NPI: 1124572854
Provider Name (Legal Business Name): ANDROS FRAILEY HAZIPETROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HAMILTON ST
PHILADELPHIA PA
19130-3814
US

IV. Provider business mailing address

135 SUNRISE AVE
LANCASTER PA
17601-3943
US

V. Phone/Fax

Practice location:
  • Phone: 215-567-2017
  • Fax:
Mailing address:
  • Phone: 717-490-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450684
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: