Healthcare Provider Details

I. General information

NPI: 1104397298
Provider Name (Legal Business Name): BARBARA MARIE BISH PHARMD, CRPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIE BARBARA BISH PHARMD, CRPH

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 DOUGLAS AVE
SAINT AUGUSTINE FL
32084-1227
US

IV. Provider business mailing address

87 DOUGLAS AVE
SAINT AUGUSTINE FL
32084-1227
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-5111
  • Fax:
Mailing address:
  • Phone: 904-826-5111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: