Provider Demographics
NPI:1548743669
Name:HENDERSHOTT, CALEB ANDREW (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:ANDREW
Last Name:HENDERSHOTT
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 1:11454 52ND CT E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-5827
Mailing Address - Country:US
Mailing Address - Phone:904-655-9276
Mailing Address - Fax:
Practice Address - Street 1:1220 KINGSWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2514
Practice Address - Country:US
Practice Address - Phone:813-685-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist