Provider Demographics
NPI:1922377647
Name:WEDEKIND, SHANNON (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:
Last Name:WEDEKIND
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 1:7003 PRESIDENTS DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-5517
Mailing Address - Country:US
Mailing Address - Phone:407-859-6197
Mailing Address - Fax:
Practice Address - Street 1:7003 PRESIDENTS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5517
Practice Address - Country:US
Practice Address - Phone:407-859-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34618183500000X
IL294015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist