Provider Demographics
NPI:1669740296
Name:CLUNIS, DENISE AMY (RPH)
Entity type:Individual
Prefix:MISS
First Name:DENISE
Middle Name:AMY
Last Name:CLUNIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 AVALON PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6666
Mailing Address - Country:US
Mailing Address - Phone:407-736-8045
Mailing Address - Fax:407-736-8493
Practice Address - Street 1:1000 AVALON PARK BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6666
Practice Address - Country:US
Practice Address - Phone:407-736-8045
Practice Address - Fax:407-736-8493
Is Sole Proprietor?:No
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist