Provider Demographics
NPI:1871878264
Name:KURZ, ANDREW B (RPH)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:B
Last Name:KURZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 N FROSTWOOD PKWY
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2804
Mailing Address - Country:US
Mailing Address - Phone:309-363-3367
Mailing Address - Fax:
Practice Address - Street 1:221 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-5640
Practice Address - Country:US
Practice Address - Phone:309-673-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051039019183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist