=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821606385
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZACHARY HINKLE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2020
-----------------------------------------------------
Last Update Date | 07/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3100 LITTLE RD
-----------------------------------------------------
City | TRINITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34655-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-375-1609
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1607 PARKER POINTE BLVD
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33556-4039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-815-5148
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS60893
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------