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NPI Code Detail

MEDICARE: BLAKE HERSCHBERGER

MEDICARE: BLAKE HERSCHBERGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS61520FL

General Provider Information

NPI Number : 1255945465
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE HERSCHBERGER
Provider Business Mailing Address
First Line : 2765 NW 49TH AVE UNIT 301
Second Line :
City : OCALA
State : FL
Zip : 34482-6215
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2765 NW 49TH AVE UNIT 301
Second Line :
City : OCALA
State : FL
Zip : 34482-6215
Country : US
Telephone Number : 352-401-3606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2020
Last Update Date : 09/04/2020

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Directions to “ BLAKE HERSCHBERGER ” Practice Location

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