Provider Demographics
NPI:1932699287
Name:TALATI, NISHANT TARUNKUMAR (PHARM D)
Entity Type:Individual
Prefix:
First Name:NISHANT
Middle Name:TARUNKUMAR
Last Name:TALATI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12405 BEACONTREE WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6582
Mailing Address - Country:US
Mailing Address - Phone:201-214-5084
Mailing Address - Fax:
Practice Address - Street 1:290 CITRUS TOWER BLVD STE 106
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2783
Practice Address - Country:US
Practice Address - Phone:352-989-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-12
Last Update Date:2018-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS545001835P0018X
NJ28RI039140001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS54500OtherSTATE OF FLORIDA-DEPARTMENT OF HEALTH
NJ28RI03914000OtherNEW JERSEY OFFICE OF THE ATTORNEY GENERAL