Provider Demographics
NPI:1962558387
Name:FEDER, IRWIN C
Entity type:Individual
Prefix:
First Name:IRWIN
Middle Name:C
Last Name:FEDER
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 1:730 SAN JUAN DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6225
Mailing Address - Country:US
Mailing Address - Phone:305-667-0741
Mailing Address - Fax:305-667-0744
Practice Address - Street 1:730 SAN JUAN DR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33143-6225
Practice Address - Country:US
Practice Address - Phone:305-667-0741
Practice Address - Fax:305-667-0744
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist