Provider Demographics
NPI:1639541733
Name:NAN PHARM INC
Entity Type:Organization
Organization Name:NAN PHARM INC
Other - Org Name:VP PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MR
Authorized Official - Prefix:
Authorized Official - First Name:NANDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-205-1546
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:813-205-1546
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:813-205-1546
Practice Address - Fax:813-988-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
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?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty