# ANDREA POLK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1255077293
- **Gender:** F
- **Credential:** CPHT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | 1124201215 | TX | Yes |

## Other

- **Enumeration date:** 05/11/2022
- **Last updated:** 05/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 102239 | STATE PHARMACY LICENSE | TX |