Provider Demographics
NPI:1477196251
Name:HARRIDAN, VANITA AMANDA (PHARMD)
Entity Type:Individual
Prefix:
First Name:VANITA
Middle Name:AMANDA
Last Name:HARRIDAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 BEARING LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5921
Mailing Address - Country:US
Mailing Address - Phone:407-271-7544
Mailing Address - Fax:
Practice Address - Street 1:2750 W NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:32904-3706
Practice Address - Country:US
Practice Address - Phone:321-722-9262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist