MEDICARE: DR. ANDREA DAWN GARDNER PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1200X	Pharmacotherapy Pharmacist	P5258	ID

General Provider Information

NPI Number	:	1326026972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA DAWN GARDNER PHARM.D.

Provider Business Mailing Address
First Line	:	1500 PALISADE BLVD
Second Line	:
City	:	DUPONT
State	:	WA
Zip	:	98327-9701
Country	:	US
Telephone Number	:	253-964-8538
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BARNES STREET
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438-1303
Country	:	US
Telephone Number	:	253-982-6535
Fax Number	:	253-982-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	07/08/2007

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