=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427479096
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS KUNNEN PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2013
-----------------------------------------------------
Last Update Date | 12/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 BLANDING BLVD
-----------------------------------------------------
City | ORANGE PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32073-5051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-276-6035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 170 STAPLEHURST DR
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-3271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-430-4273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS47746
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------