Healthcare Provider Details

I. General information

NPI: 1811821937
Provider Name (Legal Business Name): ILA BAGHERI CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 SW 13TH ST
GAINESVILLE FL
32608-1524
US

IV. Provider business mailing address

12326 HAMLIN BLVD
WEST PALM BEACH FL
33412-2346
US

V. Phone/Fax

Practice location:
  • Phone: 135-233-6338
  • Fax:
Mailing address:
  • Phone: 561-801-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number1978728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: