Provider Demographics
NPI:1578846689
Name:BACCHUS, BIBI SHAMIZA
Entity Type:Individual
Prefix:MRS
First Name:BIBI
Middle Name:SHAMIZA
Last Name:BACCHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 WILLOUGHBY CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-9307
Mailing Address - Country:US
Mailing Address - Phone:561-439-9846
Mailing Address - Fax:
Practice Address - Street 1:105 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3205
Practice Address - Country:US
Practice Address - Phone:561-540-4423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35429183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist