Provider Demographics
NPI:1568591311
Name:BIGELOW, HERBERT NMN
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:NMN
Last Name:BIGELOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 TEALWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685
Mailing Address - Country:US
Mailing Address - Phone:727-216-3329
Mailing Address - Fax:813-933-6631
Practice Address - Street 1:8438 N ARMENIA AVE
Practice Address - Street 2:WINN DIXIE 0639
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604
Practice Address - Country:US
Practice Address - Phone:813-931-7728
Practice Address - Fax:813-933-6631
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0008206183500000X
OH03306119183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist