Provider Demographics
NPI:1114920337
Name:BARDIN, MATTHEW CAMPBELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CAMPBELL
Last Name:BARDIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 S QUEENSWAY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2439
Mailing Address - Country:US
Mailing Address - Phone:813-980-3581
Mailing Address - Fax:
Practice Address - Street 1:301 N ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4303
Practice Address - Country:US
Practice Address - Phone:813-757-1233
Practice Address - Fax:813-757-1234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS351611835P1200X, 1835N1003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered183500000XPharmacy Service ProvidersPharmacist