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Individual

DR. BROCK SHANE BAXTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHARMD

Contact information

Practice address
6501 HARBISON AVE, PHILADELPHIA, PA 19149-2912
(215) 333-4300
Mailing address
2200 E CAMBRIA ST, PHILADELPHIA, PA 19134-3906
(215) 518-7066

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP447654
PA
183500000X
Pharmacist
RRP447654
PA

Other

Enumeration date
11/16/2020
Last updated
11/16/2020
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