Provider Demographics
NPI:1093306177
Name:TOOM, PRANITHA
Entity Type:Individual
Prefix:
First Name:PRANITHA
Middle Name:
Last Name:TOOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9018 ARBORS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-9538
Mailing Address - Country:US
Mailing Address - Phone:408-454-4119
Mailing Address - Fax:
Practice Address - Street 1:2775 OLD WINTER GARDEN RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2995
Practice Address - Country:US
Practice Address - Phone:407-813-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist