Provider Demographics
NPI:1891810107
Name:DUNN, CARMELLA LYNET (RPH)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:LYNET
Last Name:DUNN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:CARMELLA
Other - Middle Name:LYNET
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:4330 S 6TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4276
Mailing Address - Country:US
Mailing Address - Phone:812-251-9877
Mailing Address - Fax:
Practice Address - Street 1:4330 S 6TH ST
Practice Address - Street 2:APT 1
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4276
Practice Address - Country:US
Practice Address - Phone:812-251-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist