Provider Demographics
NPI:1003183971
Name:PAINTER, JOHN (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:PAINTER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7403
Mailing Address - Country:US
Mailing Address - Phone:954-942-2002
Mailing Address - Fax:
Practice Address - Street 1:1101 E ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7403
Practice Address - Country:US
Practice Address - Phone:954-942-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist