Provider Demographics
NPI:1295875961
Name:GANNON, JAMES E (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:GANNON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 TUFTS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8939
Mailing Address - Country:US
Mailing Address - Phone:239-936-3211
Mailing Address - Fax:239-332-9671
Practice Address - Street 1:3920 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-2205
Practice Address - Country:US
Practice Address - Phone:239-332-9552
Practice Address - Fax:239-332-9671
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS9218183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist