Provider Demographics
NPI:1376261271
Name:SOMMERVILLE, DEANNE LYN (RPH)
Entity Type:Individual
Prefix:
First Name:DEANNE
Middle Name:LYN
Last Name:SOMMERVILLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 MAUVE TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-0728
Mailing Address - Country:US
Mailing Address - Phone:203-770-5066
Mailing Address - Fax:
Practice Address - Street 1:27680 BERMONT RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-1901
Practice Address - Country:US
Practice Address - Phone:941-505-9208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist