Provider Demographics
NPI:1699090969
Name:FEDIDA, MICHAEL (RPH, MS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FEDIDA
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1710
Mailing Address - Country:US
Mailing Address - Phone:201-836-7003
Mailing Address - Fax:201-836-5886
Practice Address - Street 1:527 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1710
Practice Address - Country:US
Practice Address - Phone:201-836-7003
Practice Address - Fax:201-836-5886
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI0196700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist