Provider Demographics
NPI:1407955826
Name:BADDAM, SATISH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SATISH
Middle Name:
Last Name:BADDAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3486 LAUREL LEAF DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-5273
Mailing Address - Country:US
Mailing Address - Phone:904-525-1186
Mailing Address - Fax:904-778-2800
Practice Address - Street 1:3538 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-5253
Practice Address - Country:US
Practice Address - Phone:904-778-7200
Practice Address - Fax:904-778-2800
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0037113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist