Provider Demographics
NPI:1316549256
Name:ANDRICKSON, FERNANDO ALFREDO (PHARMD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ALFREDO
Last Name:ANDRICKSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 W PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-5600
Mailing Address - Country:US
Mailing Address - Phone:321-354-2213
Mailing Address - Fax:
Practice Address - Street 1:3101 W PRINCETON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-5600
Practice Address - Country:US
Practice Address - Phone:321-354-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist