Provider Demographics
NPI:1912053372
Name:CHANNER, BARBARA M (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:M
Last Name:CHANNER
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 1:4541 LITTLE PALM LN
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-5113
Mailing Address - Country:US
Mailing Address - Phone:954-481-9960
Mailing Address - Fax:954-724-3488
Practice Address - Street 1:7967 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-8428
Practice Address - Country:US
Practice Address - Phone:954-724-3799
Practice Address - Fax:954-724-3488
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist