Provider Demographics
NPI:1881926079
Name:PACK, DEBORAH M (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:M
Last Name:PACK
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 1:104 TUSCANY WAY
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-2877
Mailing Address - Country:US
Mailing Address - Phone:850-249-7790
Mailing Address - Fax:
Practice Address - Street 1:7100 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-4801
Practice Address - Country:US
Practice Address - Phone:850-234-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0030807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist