Healthcare Provider Details

I. General information

NPI: 1245834514
Provider Name (Legal Business Name): HENRY NASH BAKER III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2020
Last Update Date: 11/26/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 CAROLINE ST
MILTON FL
32570-4582
US

IV. Provider business mailing address

6501 CAROLINE ST
MILTON FL
32570-4582
US

V. Phone/Fax

Practice location:
  • Phone: 850-623-0133
  • Fax:
Mailing address:
  • Phone: 850-623-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57953
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: