Provider Demographics
NPI:1730057571
Name:DEMELLA, FREDERICK JR (RPH)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:
Last Name:DEMELLA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:
Other - Last Name:DE MELLA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:2595 TARPON COVE DR APT 1212
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-1915
Mailing Address - Country:US
Mailing Address - Phone:941-629-1181
Mailing Address - Fax:
Practice Address - Street 1:2595 TARPON COVE DR APT 1212
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-1915
Practice Address - Country:US
Practice Address - Phone:941-629-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02020127951835P0018X
CTPCT.00057641835P0018X
FLPS531401835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist