Healthcare Provider Details

I. General information

NPI: 1740101286
Provider Name (Legal Business Name): AUDRA ANDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

V. Phone/Fax

Practice location:
  • Phone: 608-466-0384
  • Fax:
Mailing address:
  • Phone: 608-466-0384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS63634
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: