Provider Demographics
NPI:1124366729
Name:PERSAD, TRISHA (PHARM D)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:
Last Name:PERSAD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 NORTHGREEN AVE APT 2205
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3094
Mailing Address - Country:US
Mailing Address - Phone:561-762-7027
Mailing Address - Fax:
Practice Address - Street 1:3802 NORTHGREEN AVE APT 2205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-3094
Practice Address - Country:US
Practice Address - Phone:561-762-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist