Provider Demographics
NPI:1043796782
Name:MUNNS, ALYSSA MEAGAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MEAGAN
Last Name:MUNNS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:MEAGAN
Other - Last Name:MUNNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1246 WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-2321
Mailing Address - Country:US
Mailing Address - Phone:850-726-0174
Mailing Address - Fax:
Practice Address - Street 1:1226 FREEPORT HWY S
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32435-3396
Practice Address - Country:US
Practice Address - Phone:850-892-6914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19528183500000X
FLPS54920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist