Provider Demographics
NPI:1023656212
Name:MUZZARELLI, ANDREA JO (RPH)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JO
Last Name:MUZZARELLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13784 W COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-7004
Mailing Address - Country:US
Mailing Address - Phone:708-220-2201
Mailing Address - Fax:
Practice Address - Street 1:20 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5805
Practice Address - Country:US
Practice Address - Phone:928-282-8569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS007207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist