Provider Demographics
NPI:1447582697
Name:DUNK, JOHN LESLIE (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LESLIE
Last Name:DUNK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8468 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CURRAN
Mailing Address - State:MI
Mailing Address - Zip Code:48728-9709
Mailing Address - Country:US
Mailing Address - Phone:386-984-9148
Mailing Address - Fax:
Practice Address - Street 1:5719 N US HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:OSCODA
Practice Address - State:MI
Practice Address - Zip Code:48750-8721
Practice Address - Country:US
Practice Address - Phone:989-739-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039602183500000X
FL32575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist