Basic Information
| Provider Information | |||||||||
| NPI: | 1457762593 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILLEEN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 120 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921033007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192601010 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 120 UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192601010 | ||||||||
| FaxNumber: | 6192601031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 03/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | N | Other Service Providers | Health Educator | 1835P0018X | 69981 | CA | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 183500000X | 69981 | CA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.