Provider Demographics
NPI:1104397298
Name:BISH, BARBARA MARIE (PHARMD, CRPH)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MARIE
Last Name:BISH
Suffix:
Gender:F
Credentials:PHARMD, CRPH
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:BARBARA
Other - Last Name:BISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD, CRPH
Mailing Address - Street 1:87 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1227
Mailing Address - Country:US
Mailing Address - Phone:904-826-5111
Mailing Address - Fax:
Practice Address - Street 1:87 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1227
Practice Address - Country:US
Practice Address - Phone:904-826-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist