Provider Demographics
NPI:1740885094
Name:HANDSHOE, BARRIE (RPH)
Entity type:Individual
Prefix:
First Name:BARRIE
Middle Name:
Last Name:HANDSHOE
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 1:4395 WINONA LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2532
Mailing Address - Country:US
Mailing Address - Phone:606-260-5033
Mailing Address - Fax:
Practice Address - Street 1:27040 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4824
Practice Address - Country:US
Practice Address - Phone:251-621-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010245183500000X
AL18474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist