Captain Brathwaite, PHARMD
Individual provider Active NPI Pharmacist · Dade City, FL
NPI 1992560775 · NPPES record last updated Feb 20, 2024
Key facts
- NPI
- 1992560775
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- PS65987 (FL)
- Practice address
- 14306 7TH St
Dade City, FL 33523-3434 - Phone
- (352) 567-2238
- NPI assigned
- Feb 20, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS65987 | FL | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS65987 | FL | Yes |
Addresses
Primary practice location
14306 7TH St
Dade City, FL 33523-3434
Mailing address
3165 SW 67TH Ave
Miramar, FL 33023-4820
Phone (954) 549-7456
Other providers in Dade City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.