Provider Demographics
NPI:1790066744
Name:GASKIN, MICHAEL M (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:GASKIN
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 1:1150 MALABAR RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3239
Mailing Address - Country:US
Mailing Address - Phone:321-727-3781
Mailing Address - Fax:321-727-2709
Practice Address - Street 1:1150 MALABAR RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3239
Practice Address - Country:US
Practice Address - Phone:321-727-3781
Practice Address - Fax:321-727-2709
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist