Healthcare Provider Details

I. General information

NPI: 1326026972
Provider Name (Legal Business Name): ANDREA DAWN GARDNER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BARNES STREET
MCCHORD AFB WA
98438-1303
US

IV. Provider business mailing address

1500 PALISADE BLVD
DUPONT WA
98327-9701
US

V. Phone/Fax

Practice location:
  • Phone: 253-982-6535
  • Fax: 253-982-8401
Mailing address:
  • Phone: 253-964-8538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberP5258
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: