Provider Demographics
NPI:1255055380
Name:ZEPP, WAYNE MORRIS JR
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:MORRIS
Last Name:ZEPP
Suffix:JR
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 1:7435 S CINDY PT
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-3561
Mailing Address - Country:US
Mailing Address - Phone:352-257-7990
Mailing Address - Fax:
Practice Address - Street 1:3959 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2604
Practice Address - Country:US
Practice Address - Phone:352-628-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90577183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician