Provider Demographics
NPI:1417053687
Name:PERSAD, KRISHNA (RPH)
Entity Type:Individual
Prefix:MR
First Name:KRISHNA
Middle Name:
Last Name:PERSAD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10010 OAKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5938
Mailing Address - Country:US
Mailing Address - Phone:407-370-0962
Mailing Address - Fax:
Practice Address - Street 1:11957 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-7025
Practice Address - Country:US
Practice Address - Phone:407-465-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist