Provider Demographics
NPI:1376191874
Name:DUNEVANT, MARC (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:DUNEVANT
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 1:688 NW 133RD DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6153
Mailing Address - Country:US
Mailing Address - Phone:954-552-3194
Mailing Address - Fax:
Practice Address - Street 1:1181 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3322
Practice Address - Country:US
Practice Address - Phone:954-577-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist