Provider Demographics
NPI:1558096628
Name:ATANDA, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ATANDA
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 1:1706 BONITA BLUFF CT
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3228
Mailing Address - Country:US
Mailing Address - Phone:813-545-8662
Mailing Address - Fax:
Practice Address - Street 1:1706 BONITA BLUFF CT
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3228
Practice Address - Country:US
Practice Address - Phone:813-545-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist