Provider Demographics
NPI:1588950034
Name:FAUCETTE, DEBORAH JEAN (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:FAUCETTE
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 1:3625 W GANDY BLVD
Mailing Address - Street 2:TARGET T-1051
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-2607
Mailing Address - Country:US
Mailing Address - Phone:813-835-9414
Mailing Address - Fax:813-835-9414
Practice Address - Street 1:3625 W GANDY BLVD
Practice Address - Street 2:TARGET T-1051
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-2607
Practice Address - Country:US
Practice Address - Phone:813-835-9414
Practice Address - Fax:813-835-9414
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 24291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist