Provider Demographics
NPI:1417308107
Name:JUNGCLAUS, ABBEY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:JUNGCLAUS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8917 N DAVIS HWY APT 70
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5328
Mailing Address - Country:US
Mailing Address - Phone:812-569-0832
Mailing Address - Fax:
Practice Address - Street 1:2912 DAUPHIN ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3839
Practice Address - Country:US
Practice Address - Phone:251-478-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist