Provider Demographics
NPI:1770753733
Name:GRASSO, ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GRASSO
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 1:2200 BERQUIST DRIVE SUITE 1
Mailing Address - Street 2:WILFORD HALL MEDICAL CENTER
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5300
Mailing Address - Country:US
Mailing Address - Phone:210-292-7202
Mailing Address - Fax:210-292-7207
Practice Address - Street 1:2200 BERQUIST DRIVE SUITE 1
Practice Address - Street 2:WILFORD HALL MEDICAL CENTER
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-7202
Practice Address - Fax:210-292-7207
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist