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General NPI Number Information
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NPI Number | 1730057571
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Entity Type | Individual
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Provider Name | FREDERICK DEMELLA JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 10/24/2025
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2595 TARPON COVE DR APT 1212
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City | PUNTA GORDA
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State | FL
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Zip | 33950-1915
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Country | US
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Telephone | 941-629-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 2595 TARPON COVE DR APT 1212
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City | PUNTA GORDA
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State | FL
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Zip | 33950-1915
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Country | US
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Telephone | 941-629-1181
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 0202012795
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PCT.0005764
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS53140
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License Number State | FL
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