Healthcare Provider Details

I. General information

NPI: 1073239083
Provider Name (Legal Business Name): HEALTHSTAT WELLNESS PASCO-PORT RICHEY DISPENSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8606 GOVERNMENT DR STE 3
NEW PORT RICHEY FL
34654-5510
US

IV. Provider business mailing address

10 W MARKET ST STE 2900
INDIANAPOLIS IN
46204-2964
US

V. Phone/Fax

Practice location:
  • Phone: 704-529-6161
  • Fax:
Mailing address:
  • Phone: 866-434-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TOBIAS D. BARKER
Title or Position: PRESIDENT
Credential: MD
Phone: 781-366-1655