Provider Demographics
NPI:1396075651
Name:PHARA INC
Entity type:Organization
Organization Name:PHARA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PHARA
Authorized Official - Middle Name:JOURDAN
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN
Authorized Official - Phone:617-461-8503
Mailing Address - Street 1:135 NW MAGNOLIA LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3568
Mailing Address - Country:US
Mailing Address - Phone:617-461-8503
Mailing Address - Fax:617-249-1769
Practice Address - Street 1:135 NW MAGNOLIA LAKES BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3568
Practice Address - Country:US
Practice Address - Phone:617-461-8503
Practice Address - Fax:617-249-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-10
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5606133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty