Healthcare Provider Details

I. General information

NPI: 1588528046
Provider Name (Legal Business Name): MERCY J NINAN PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 N PARK RD
PLANT CITY FL
33563-2026
US

IV. Provider business mailing address

2819 MYSTIC OAKS DR
PLANT CITY FL
33563-9004
US

V. Phone/Fax

Practice location:
  • Phone: 813-757-1274
  • Fax:
Mailing address:
  • Phone: 813-757-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberPU5995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: