Provider Demographics
NPI:1972880607
Name:NATHOO, DEEPAK DALSUKH
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:DALSUKH
Last Name:NATHOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 S US HIGHWAY 17/92
Mailing Address - Street 2:T0898
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-3290
Mailing Address - Country:US
Mailing Address - Phone:407-830-6363
Mailing Address - Fax:
Practice Address - Street 1:4410 S US HIGHWAY 17/92
Practice Address - Street 2:T0898
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-3290
Practice Address - Country:US
Practice Address - Phone:407-830-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20496183500000X
IN26015009A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist