Provider Demographics
NPI:1770046179
Name:YASMIN MED LLC
Entity Type:Organization
Organization Name:YASMIN MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANTHULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-708-4219
Mailing Address - Street 1:17075 CAGAN RIDGE BLVD STE 100B
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-9619
Mailing Address - Country:US
Mailing Address - Phone:352-708-4219
Mailing Address - Fax:352-708-4583
Practice Address - Street 1:17075 CAGAN RIDGE BLVD STE 100B
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-9619
Practice Address - Country:US
Practice Address - Phone:352-708-4219
Practice Address - Fax:352-708-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy