Provider Demographics
NPI:1184899346
Name:PLUMMER, MARK STEVEN
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:PLUMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-0214
Mailing Address - Country:US
Mailing Address - Phone:850-643-2516
Mailing Address - Fax:
Practice Address - Street 1:16059 NW LAKESIDE LN
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3933
Practice Address - Country:US
Practice Address - Phone:850-643-2516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS15746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist