Provider Demographics
NPI:1225627300
Name:JEAN-BAPTISTE, DIDRICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:DIDRICK
Middle Name:
Last Name:JEAN-BAPTISTE
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 1:576 SW CRAWFISH DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7660
Mailing Address - Country:US
Mailing Address - Phone:772-226-0848
Mailing Address - Fax:
Practice Address - Street 1:3045 SW PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3226
Practice Address - Country:US
Practice Address - Phone:772-301-6124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist