Healthcare Provider Details

I. General information

NPI: 1437423498
Provider Name (Legal Business Name): TAKA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1084 LEE RD STE 4
ORLANDO FL
32810-5821
US

IV. Provider business mailing address

1084 LEE RD SUITE 4
ORLANDO FL
32810-5821
US

V. Phone/Fax

Practice location:
  • Phone: 407-730-2770
  • Fax: 407-730-2764
Mailing address:
  • Phone: 407-730-2770
  • Fax: 407-730-2764

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 NumberPH25991
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: THANH-THUY NGUYEN
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 407-730-2770