Provider Demographics
NPI:1346311099
Name:FANDETTI, JOHN C III (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:C
Last Name:FANDETTI
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2436 GLASCOTT PT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-6320
Mailing Address - Country:US
Mailing Address - Phone:205-941-9905
Mailing Address - Fax:954-457-7164
Practice Address - Street 1:2500 E HALLANDALE BCH BLVD
Practice Address - Street 2:BUDGET DRUGS
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-457-8011
Practice Address - Fax:954-457-7164
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPS19901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist