Provider Demographics
NPI:1912311184
Name:FELDER, ANDRE SR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:FELDER
Suffix:SR
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:
Other - Last Name:FELDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:300 SW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-8540
Mailing Address - Country:US
Mailing Address - Phone:352-379-0110
Mailing Address - Fax:352-380-9777
Practice Address - Street 1:300 SW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-8540
Practice Address - Country:US
Practice Address - Phone:352-379-0110
Practice Address - Fax:352-380-9777
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist