Provider Demographics
NPI:1528602067
Name:HORNBACK, RICK (RPH)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:HORNBACK
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 1:7321 43RD ST E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-5106
Mailing Address - Country:US
Mailing Address - Phone:941-539-1754
Mailing Address - Fax:
Practice Address - Street 1:3500 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-5358
Practice Address - Country:US
Practice Address - Phone:941-444-8415
Practice Address - Fax:941-444-8411
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist