Provider Demographics
NPI:1730166133
Name:CEFALU, ANDREW JOSEPH (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOSEPH
Last Name:CEFALU
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:AR
Mailing Address - Zip Code:71640-3059
Mailing Address - Country:US
Mailing Address - Phone:870-355-2046
Mailing Address - Fax:870-355-2444
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUDORA
Practice Address - State:AR
Practice Address - Zip Code:71640-3059
Practice Address - Country:US
Practice Address - Phone:870-355-2046
Practice Address - Fax:870-355-2444
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist