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General NPI Number Information
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NPI Number | 1447715628
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Entity Type | Individual
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Provider Name | GERALD MATTHEW MANDRELL RPH
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Gender | Male
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 1950 COMMONWEALTH LN
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City | TALLAHASSEE
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State | FL
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Zip | 32303-3196
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Country | US
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Telephone | 850-504-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 CHOWKEEBIN CT
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City | TALLAHASSEE
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State | FL
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Zip | 32301-5870
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Country | US
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Telephone | 850-322-5313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS18142
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License Number State | FL
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