MEDICARE: DR. ANDREA MARLENE ALVAREZ 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	183500000X	Pharmacist	P5883	ID

General Provider Information

NPI Number	:	1417181140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA MARLENE ALVAREZ PHARM D

Provider Business Mailing Address
First Line	:	17750 POLARA WAY
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83687-9186
Country	:	US
Telephone Number	:	208-467-9455
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-463-2903
Fax Number	:	208-468-0215

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

Provider Enumeration Date	:	05/09/2009
Last Update Date	:	05/09/2009

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