Provider Demographics
NPI:1558644989
Name:VANCE, JOHN CAMERON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CAMERON
Last Name:VANCE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-4733
Mailing Address - Country:US
Mailing Address - Phone:850-385-7104
Mailing Address - Fax:
Practice Address - Street 1:2349 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-4733
Practice Address - Country:US
Practice Address - Phone:850-385-7104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45443183500000X
WVRP0007275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist