MEDICARE: SRUTHY JOSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS61091	FL

General Provider Information

NPI Number	:	1013513043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SRUTHY JOSE

Provider Business Mailing Address
First Line	:	6512 SAND LAKE SOUND RD APT NO2311
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7499
Country	:	US
Telephone Number	:	813-453-2693
Fax Number	:

Provider Business Practice Location Address
First Line	:	6790 CENTRAL FLORIDA PKWY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6025
Country	:	US
Telephone Number	:	407-238-4726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2020
Last Update Date	:	12/06/2020

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Directions to “ SRUTHY JOSE ” Practice Location

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