Provider Demographics
NPI:1962081067
Name:TAILOR, KEVAN NIKUNJ (RPH)
Entity type:Individual
Prefix:
First Name:KEVAN
Middle Name:NIKUNJ
Last Name:TAILOR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4531
Mailing Address - Country:US
Mailing Address - Phone:407-809-3266
Mailing Address - Fax:407-593-8261
Practice Address - Street 1:520 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4531
Practice Address - Country:US
Practice Address - Phone:407-809-3266
Practice Address - Fax:407-593-8261
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS53372OtherSTATE LICENSE