Provider Demographics
NPI:1386646388
Name:HALBERT, MICHAEL R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:HALBERT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:R
Other - Last Name:HALBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:109 18TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2734
Mailing Address - Country:US
Mailing Address - Phone:727-515-9261
Mailing Address - Fax:
Practice Address - Street 1:109 18TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2734
Practice Address - Country:US
Practice Address - Phone:727-515-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS292041835P1200X
KY0075861835P1200X
NE85481835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy