Individual
DOUGLAS WYNN STATEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
3422 S ATLANTIC AVE, DAYTONA BEACH SHORES, FL 32118-6349
(386) 756-0481
(386) 756-0498
Mailing address
1425 S PENINSULA DR, DAYTONA BEACH, FL 32118-4829
(404) 218-9704
(386) 236-9341
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
E-08338
MS
183500000X
Pharmacist
PS44814
FL
183500000X
Pharmacist
Primary
RPH021909
GA
Other
Enumeration date
11/29/2006
Last updated
11/22/2020
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