Healthcare Provider Details

I. General information

NPI: 1164798682
Provider Name (Legal Business Name): NH PHARMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 WAYMONT CT STE 101
LAKE MARY FL
32746-3586
US

IV. Provider business mailing address

405 WAYMONT CT SUITE 101
LAKE MARY FL
32746-3586
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-2440
  • Fax: 407-322-2470
Mailing address:
  • Phone: 407-322-2440
  • Fax: 407-322-2470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26193
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NAVA HAJIABADI
Title or Position: OWNER
Credential:
Phone: 407-314-6747