MEDICARE: MRS. ANDREA MICHELLE NELSON

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	183700000X	Pharmacy Technician	RPT35394	FL

General Provider Information

NPI Number	:	1225479579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA MICHELLE NELSON

Provider Business Mailing Address
First Line	:	203 SW PARK STREET
Second Line	:	OKEECHOBEE DISCOUNT DRUGS
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972
Country	:	US
Telephone Number	:	863-763-5100
Fax Number	:	863-763-8556

Provider Business Practice Location Address
First Line	:	203 SW PARK ST
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-4160
Country	:	US
Telephone Number	:	863-763-5100
Fax Number	:	863-763-8556

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

Provider Enumeration Date	:	07/16/2013
Last Update Date	:	07/16/2013

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