Provider Demographics
NPI:1386858215
Name:HERRING, MAUREEN FAYE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:FAYE
Last Name:HERRING
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 1:3714 LAKE BUYNAK RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7708
Mailing Address - Country:US
Mailing Address - Phone:407-876-2615
Mailing Address - Fax:
Practice Address - Street 1:2600 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4752
Practice Address - Country:US
Practice Address - Phone:407-656-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS12622183500000X
FLPU2844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS12622OtherSTATE LICENSE DEP HEALTH
FLPU2844OtherCONSULTANT PHARMACIST
IN26012499AOtherPHARMACY LICENSE