Individual
ANDREA POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
2001 W JOHN CARPENTER FWY, IRVING, TX 75063-3255
(800) 379-0092
Mailing address
642 ST CHARLES CT, ARLINGTON, TX 76013-1370
(469) 401-0080
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
1124201215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102239
STATE PHARMACY LICENSE
TX
Enumeration date
05/11/2022
Last updated
05/11/2022
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