Provider Demographics
NPI:1386981397
Name:MCBREEN, DAVID WILLIAM (RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:MCBREEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 SUMMERLIN RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3005
Mailing Address - Country:US
Mailing Address - Phone:239-939-3419
Mailing Address - Fax:239-939-0238
Practice Address - Street 1:4600 SUMMERLIN RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3005
Practice Address - Country:US
Practice Address - Phone:239-939-3419
Practice Address - Fax:239-939-0238
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist