Provider Demographics
NPI:1194930347
Name:BABOOLALL, BRIAN TARACHAND (RPH)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:TARACHAND
Last Name:BABOOLALL
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 1:4545 SE 31ST PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7335
Mailing Address - Country:US
Mailing Address - Phone:352-624-7356
Mailing Address - Fax:
Practice Address - Street 1:4545 SE 31ST PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7335
Practice Address - Country:US
Practice Address - Phone:352-624-7356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32498183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist