Provider Demographics
NPI:1598360521
Name:BAXTER, NANCY VALINICA (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:VALINICA
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-5890
Mailing Address - Country:US
Mailing Address - Phone:352-243-0135
Mailing Address - Fax:352-243-0594
Practice Address - Street 1:1640 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-5890
Practice Address - Country:US
Practice Address - Phone:352-243-0135
Practice Address - Fax:352-243-0594
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist