Provider Demographics
NPI:1275020802
Name:BITTINGER, DEVAN
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:
Last Name:BITTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17809 SAILFISH DR APT C
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-6607
Mailing Address - Country:US
Mailing Address - Phone:804-349-4067
Mailing Address - Fax:
Practice Address - Street 1:17809 SAILFISH DR APT C
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-6607
Practice Address - Country:US
Practice Address - Phone:804-349-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy