Provider Demographics
NPI:1770857260
Name:RAMANATHAN, MEYYAPPAN (R PH)
Entity Type:Individual
Prefix:MR
First Name:MEYYAPPAN
Middle Name:
Last Name:RAMANATHAN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 LONDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6303
Mailing Address - Country:US
Mailing Address - Phone:570-341-5728
Mailing Address - Fax:
Practice Address - Street 1:10500 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2946
Practice Address - Country:US
Practice Address - Phone:407-877-6910
Practice Address - Fax:407-877-6912
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist