Provider Demographics
NPI:1447555396
Name:ANANT LLC
Entity type:Organization
Organization Name:ANANT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HETAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-989-5913
Mailing Address - Street 1:16744 CAGAN CROSSINGS BLVD
Mailing Address - Street 2:SUITE 207 A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-4886
Mailing Address - Country:US
Mailing Address - Phone:352-989-5913
Mailing Address - Fax:352-989-5914
Practice Address - Street 1:16744 CAGAN CROSSINGS BLVD
Practice Address - Street 2:SUITE 207 A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-4886
Practice Address - Country:US
Practice Address - Phone:352-989-5913
Practice Address - Fax:352-989-5914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X, 3336S0011X
FLPH305463336C0003X
FLPH 252123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166538OtherPK
FL7168750001Medicare NSC
FL003363101OtherMEDICAID DME PROVIDER
FL003363100Medicaid