Provider Demographics
NPI:1104138734
Name:KIMMEL, ANDREW S
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 ASPENWOOD CT.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2547
Mailing Address - Country:US
Mailing Address - Phone:407-982-6575
Mailing Address - Fax:
Practice Address - Street 1:4462 ASPENWOOD CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2547
Practice Address - Country:US
Practice Address - Phone:407-982-6575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist