Provider Demographics
NPI:1558632513
Name:MORENCY, CHANTAL (RPH)
Entity Type:Individual
Prefix:
First Name:CHANTAL
Middle Name:
Last Name:MORENCY
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 1:7526 CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2930
Mailing Address - Country:US
Mailing Address - Phone:813-263-8119
Mailing Address - Fax:
Practice Address - Street 1:4651 W KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2519
Practice Address - Country:US
Practice Address - Phone:813-286-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M652100546220OtherDRIVER LICENSE