Provider Demographics
NPI:1942548037
Name:NASR, NIRMIN MAGED
Entity Type:Individual
Prefix:
First Name:NIRMIN
Middle Name:MAGED
Last Name:NASR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LAKE WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7620
Mailing Address - Country:US
Mailing Address - Phone:321-242-0592
Mailing Address - Fax:321-242-7962
Practice Address - Street 1:3278 LAMANGA DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8524
Practice Address - Country:US
Practice Address - Phone:321-514-4694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist