Provider Demographics
NPI:1205208386
Name:PERSAD, NANDRAM
Entity Type:Individual
Prefix:
First Name:NANDRAM
Middle Name:
Last Name:PERSAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7617 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7705
Mailing Address - Country:US
Mailing Address - Phone:813-988-0818
Mailing Address - Fax:813-988-0830
Practice Address - Street 1:7617 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7705
Practice Address - Country:US
Practice Address - Phone:813-988-0818
Practice Address - Fax:813-988-0830
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH29243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist