Provider Demographics
NPI:1598002180
Name:BUNCH, DEANNA LEIGH (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:LEIGH
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 WADE GREEN RD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1267
Mailing Address - Country:US
Mailing Address - Phone:770-419-4036
Mailing Address - Fax:770-792-8362
Practice Address - Street 1:4430 WADE GREEN RD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1267
Practice Address - Country:US
Practice Address - Phone:770-419-4036
Practice Address - Fax:770-792-8362
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist