Healthcare Provider Details

I. General information

NPI: 1003803636
Provider Name (Legal Business Name): JOHN H CAULDER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPT OF VETERANS AFFAIRS 10,000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

6309 E 113TH AVE
TEMPLE TERRACE FL
33617-3137
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 813-988-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS26155
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: