Provider Demographics
NPI:1831531979
Name:CHANNER, DEBRA ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANNE
Last Name:CHANNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 NW 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12550 PROFESSIONAL PARK DRIVE UNIT 1
Practice Address - Street 2:WALGREENS CO.
Practice Address - City:FT. MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913
Practice Address - Country:US
Practice Address - Phone:239-482-1610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist