Provider Demographics
NPI:1316531759
Name:GOTFRAIND, MICHELE LYN (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYN
Last Name:GOTFRAIND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29051 DEERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-9700
Mailing Address - Country:US
Mailing Address - Phone:321-297-9702
Mailing Address - Fax:
Practice Address - Street 1:29051 DEERFIELD LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-9700
Practice Address - Country:US
Practice Address - Phone:321-297-9702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist