Provider Demographics
NPI:1710024724
Name:HALIFAX DUNN PHARMACY
Entity Type:Organization
Organization Name:HALIFAX DUNN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LOWELL
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:386-255-2090
Mailing Address - Street 1:1425 DUNN AVENUE SUITE B
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH ,
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 DUNN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1437
Practice Address - Country:US
Practice Address - Phone:386-226-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH134753336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy