Provider Demographics
NPI:1881440816
Name:JUNUTHULA, DEVENDER
Entity type:Individual
Prefix:
First Name:DEVENDER
Middle Name:
Last Name:JUNUTHULA
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 1:5628 SW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4750
Mailing Address - Country:US
Mailing Address - Phone:240-533-6753
Mailing Address - Fax:
Practice Address - Street 1:9309 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2343
Practice Address - Country:US
Practice Address - Phone:352-680-9500
Practice Address - Fax:352-680-9700
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42950183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist