Provider Demographics
NPI:1518357227
Name:MCMUNN, DEENA
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:MCMUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MEADOWBROOK MALL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9795
Mailing Address - Country:US
Mailing Address - Phone:304-842-7779
Mailing Address - Fax:304-979-9154
Practice Address - Street 1:2800 MEADOWBROOK MALL
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9795
Practice Address - Country:US
Practice Address - Phone:304-842-7779
Practice Address - Fax:304-979-9154
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV5777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist