MEDICARE: ANDREW GEORGE ITEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS67306	FL

General Provider Information

NPI Number	:	1427928787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW GEORGE ITEN

Provider Business Mailing Address
First Line	:	1225 LOGGER HEAD CIR UNIT 7-206
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33896-9780
Country	:	US
Telephone Number	:	419-544-3247
Fax Number	:

Provider Business Practice Location Address
First Line	:	40079 HIGHWAY 27
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-7800
Country	:	US
Telephone Number	:	863-547-3903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/19/2025

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Directions to “ ANDREW GEORGE ITEN ” Practice Location

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