Provider Demographics
NPI:1013517671
Name:PRASAD, PURNA (PHARMD)
Entity type:Individual
Prefix:
First Name:PURNA
Middle Name:
Last Name:PRASAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 W SAINT CONRAD ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2918
Mailing Address - Country:US
Mailing Address - Phone:772-240-4611
Mailing Address - Fax:
Practice Address - Street 1:201 34TH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8552
Practice Address - Country:US
Practice Address - Phone:727-803-9607
Practice Address - Fax:727-803-4962
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist