Provider Demographics
NPI:1154964104
Name:MERVIN, IANA (PHARMD)
Entity type:Individual
Prefix:
First Name:IANA
Middle Name:
Last Name:MERVIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 AIRPORT PULLING RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2407
Mailing Address - Country:US
Mailing Address - Phone:239-213-3359
Mailing Address - Fax:239-213-4212
Practice Address - Street 1:5010 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2407
Practice Address - Country:US
Practice Address - Phone:239-213-3359
Practice Address - Fax:239-213-4212
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist