Provider Demographics
NPI:1063016368
Name:PUNANCY, JUSTIN CLAUDE (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CLAUDE
Last Name:PUNANCY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19208 CLOISTER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4856
Mailing Address - Country:US
Mailing Address - Phone:561-866-6541
Mailing Address - Fax:
Practice Address - Street 1:7030 S JOG RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7607
Practice Address - Country:US
Practice Address - Phone:561-967-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist