Provider Demographics
NPI:1861691909
Name:RUYGROK, ANDREA C (PHARMD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:RUYGROK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9459
Mailing Address - Country:US
Mailing Address - Phone:828-230-0299
Mailing Address - Fax:
Practice Address - Street 1:445 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4565
Practice Address - Country:US
Practice Address - Phone:828-230-0299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16540183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16540OtherNC BOP