Healthcare Provider Details

I. General information

NPI: 1861831745
Provider Name (Legal Business Name): NUR CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E MICHIGAN ST STE 4
ORLANDO FL
32806-4511
US

IV. Provider business mailing address

2212 S CHICKASAW TRL #146
ORLANDO FL
32825-8414
US

V. Phone/Fax

Practice location:
  • Phone: 407-286-2964
  • Fax:
Mailing address:
  • Phone: 321-251-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH26787
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH26787
License Number StateFL

VIII. Authorized Official

Name: SUSAN BALKARAN
Title or Position: MANAGER
Credential: RPH, CPH
Phone: 321-251-1837