Provider Demographics
NPI:1619214210
Name:SHIVBARAN, DEORAM KEVIN (PHARM D)
Entity type:Individual
Prefix:PROF
First Name:DEORAM
Middle Name:KEVIN
Last Name:SHIVBARAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9359 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8560
Mailing Address - Country:US
Mailing Address - Phone:954-433-2710
Mailing Address - Fax:954-433-2715
Practice Address - Street 1:9359 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8560
Practice Address - Country:US
Practice Address - Phone:954-433-2710
Practice Address - Fax:954-433-2715
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist