Provider Demographics
NPI:1083918908
Name:DEVANNEY, WILLIAM G (CPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:DEVANNEY
Suffix:
Gender:M
Credentials:CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MIRAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:INDAILANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903
Mailing Address - Country:US
Mailing Address - Phone:321-339-5012
Mailing Address - Fax:321-312-3978
Practice Address - Street 1:700 NORTH MIRAMAR AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903
Practice Address - Country:US
Practice Address - Phone:321-339-5012
Practice Address - Fax:321-312-3978
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU5613183500000X
FLPS21628183500000X
RIRPH03565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist