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NPI Code Detail

MEDICARE: ANDREA LISA GUSDORF PD, RPH

MEDICARE: ANDREA LISA GUSDORF PD, RPH
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
11835I0206XInfectious Diseases PharmacistPD08161AR

General Provider Information

NPI Number : 1568314904
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LISA GUSDORF PD, RPH
Provider Business Mailing Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-1440
Fax Number :
Provider Business Practice Location Address
First Line : 7301 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-4100
Country : US
Telephone Number : 479-314-1440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2026
Last Update Date : 02/10/2026

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