Basic Information
| Provider Information | |||||||||
| NPI: | 1073156642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNGER | ||||||||
| FirstName: | KIRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARM D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12740 FRANK DR S | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337761726 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9020 ULMERTON RD | ||||||||
| Address2: | |||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337713820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7274315023 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2019 | ||||||||
| LastUpdateDate: | 10/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS41314 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.