Provider Demographics
NPI:1447640230
Name:GUNTER, JACKIE J (RPH)
Entity type:Individual
Prefix:MR
First Name:JACKIE
Middle Name:J
Last Name:GUNTER
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 1:4417 NW BLITCHTON RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-4056
Mailing Address - Country:US
Mailing Address - Phone:352-401-7669
Mailing Address - Fax:352-401-7634
Practice Address - Street 1:4417 NW BLITCHTON RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34482-4056
Practice Address - Country:US
Practice Address - Phone:352-401-7669
Practice Address - Fax:352-401-7634
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist