Healthcare Provider Details

I. General information

NPI: 1326972340
Provider Name (Legal Business Name): NINA ZHANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

3610 MISTY OAK DR APT 1407
MELBOURNE FL
32901-8713
US

V. Phone/Fax

Practice location:
  • Phone: 248-854-1058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS69122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: