Healthcare Provider Details

I. General information

NPI: 1689594954
Provider Name (Legal Business Name): ANDREW HAINES PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 BERTHA PALMER BLVD UNIT 2-105
TEMPLE TERRACE FL
33617-5568
US

IV. Provider business mailing address

8815 BERTHA PALMER BLVD UNIT 2-105
TEMPLE TERRACE FL
33617-5568
US

V. Phone/Fax

Practice location:
  • Phone: 863-273-4933
  • Fax:
Mailing address:
  • Phone: 863-273-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS57640
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: