1174510754 NPI number — DR. MELANIE PEGGY DETONE PHARM.D.

Table of content: DR. MELANIE PEGGY DETONE PHARM.D. (NPI 1174510754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174510754 NPI number — DR. MELANIE PEGGY DETONE PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DETONE
Provider First Name:
MELANIE
Provider Middle Name:
PEGGY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BILZ
Provider Other First Name:
MELANIE
Provider Other Middle Name:
PEGGY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174510754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3601 105TH AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-5450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-540-9242
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 BAY PINES BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33744-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-398-6661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PS 37112 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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