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NPI Code Detail

MEDICARE: KAITLYN FEDAK

MEDICARE: KAITLYN FEDAK
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
1183500000XPharmacistPS55387FL

General Provider Information

NPI Number : 1316581895
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN FEDAK
Provider Business Mailing Address
First Line : 4444 W VINE ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34746-5315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4444 W VINE ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34746-5315
Country : US
Telephone Number : 407-397-1002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2019
Last Update Date : 10/29/2019

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Directions to “ KAITLYN FEDAK ” Practice Location

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