Provider Demographics
NPI:1356944607
Name:KVEDERIS, JEFFREY P (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:P
Last Name:KVEDERIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5224
Mailing Address - Country:US
Mailing Address - Phone:941-365-1464
Mailing Address - Fax:941-365-3663
Practice Address - Street 1:2773 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5224
Practice Address - Country:US
Practice Address - Phone:941-365-1464
Practice Address - Fax:941-365-3663
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist