Healthcare Provider Details

I. General information

NPI: 1013251016
Provider Name (Legal Business Name): BART THOMAS BABNEW PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE # MP138
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1647
  • Fax:
Mailing address:
  • Phone: 321-841-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: