=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295946374
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA BENDEWALD PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 UPPER CHESAPEAKE DR
-----------------------------------------------------
City | BEL AIR
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21014-4324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-643-2282
-----------------------------------------------------
Fax | 443-643-2274
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3170 FREESTONE CT
-----------------------------------------------------
City | ABINGDON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21009-3090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-569-8593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | 15169
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------