Provider Demographics
NPI:1275667255
Name:CAVNAR, DEREK MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:MATTHEW
Last Name:CAVNAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 TURNERS MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-9777
Mailing Address - Country:US
Mailing Address - Phone:850-937-4715
Mailing Address - Fax:850-477-9692
Practice Address - Street 1:1250 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8610
Practice Address - Country:US
Practice Address - Phone:850-477-7974
Practice Address - Fax:850-477-9692
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist