Healthcare Provider Details

I. General information

NPI: 1447259288
Provider Name (Legal Business Name): GAYLON E. FRUIT RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 DARTMOOR DR
TALLAHASSEE FL
32312-1448
US

IV. Provider business mailing address

3313 DARTMOOR DR
TALLAHASSEE FL
32312-1448
US

V. Phone/Fax

Practice location:
  • Phone: 850-907-1209
  • Fax: 850-386-3643
Mailing address:
  • Phone: 850-907-1209
  • Fax: 850-386-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS15946
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: