Healthcare Provider Details

I. General information

NPI: 1982945861
Provider Name (Legal Business Name): MR. RICKEY BARNES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 E HWY 50
CLERMONT FL
34711-3184
US

IV. Provider business mailing address

3661 CUMBRIA CT
APOPKA FL
32712-5684
US

V. Phone/Fax

Practice location:
  • Phone: 352-242-9061
  • Fax:
Mailing address:
  • Phone: 321-279-6437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27940
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: