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NPI Code Detail

MEDICARE: ISAAC IDANI

MEDICARE: ISAAC IDANI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS70134FL

General Provider Information

NPI Number : 1407701808
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAAC IDANI
Provider Business Mailing Address
First Line : 4560 SW YAMADA DR
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34953-8518
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3950 N DEAN RD
Second Line :
City : ORLANDO
State : FL
Zip : 32817-5144
Country : US
Telephone Number : 407-681-6366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 03/02/2026

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Directions to “ ISAAC IDANI ” Practice Location

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