Provider Demographics
NPI:1144877788
Name:LLANES, ANDREW ALBERTO (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALBERTO
Last Name:LLANES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3437 E MELODY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-7266
Mailing Address - Country:US
Mailing Address - Phone:918-230-1913
Mailing Address - Fax:
Practice Address - Street 1:1825 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2512
Practice Address - Country:US
Practice Address - Phone:602-249-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024175183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist