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NPI Code Detail

MEDICARE: ANDRE B HARNANTO PHARMD

MEDICARE:   ANDRE B HARNANTO  PHARMD
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
1183500000XPharmacistRPH57266CA

General Provider Information

NPI Number : 1881794246
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRE B HARNANTO PHARMD
Provider Business Mailing Address
First Line : 2523 E WASHINGTON BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91104
Country : US
Telephone Number : 626-791-7600
Fax Number : 626-791-9165
Provider Business Practice Location Address
First Line : 2523 E WASHINGTON BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91104
Country : US
Telephone Number : 626-791-7600
Fax Number : 626-791-9165
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/08/2007

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Directions to “ ANDRE B HARNANTO PHARMD” Practice Location

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