Provider Demographics
NPI:1669569455
Name:BARRENTINE, JAMES C (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:BARRENTINE
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 1:292 TEQUESTA DR
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5717
Mailing Address - Country:US
Mailing Address - Phone:850-244-1226
Mailing Address - Fax:850-244-8418
Practice Address - Street 1:99 EGLIN PARKWAY NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-244-1226
Practice Address - Fax:850-244-8418
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist