Provider Demographics
NPI:1508017799
Name:COMELLAS, JOHN D (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:COMELLAS
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 1:17445 US HIGHWAY 192
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-7016
Mailing Address - Country:US
Mailing Address - Phone:352-243-0785
Mailing Address - Fax:352-243-0815
Practice Address - Street 1:17445 US HIGHWAY 192
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-7016
Practice Address - Country:US
Practice Address - Phone:352-243-0785
Practice Address - Fax:352-243-0815
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032550183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0032550OtherLISCENSE