MEDICARE: MR. KAUSHIK GHAYAL R.PH

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	PS22412	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KAUSHIK GHAYAL R.PH

Provider Business Mailing Address
First Line	:	7135 N US HIGHWAY 1
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-5087
Country	:	US
Telephone Number	:	321-631-0300
Fax Number	:	321-631-2728

Provider Business Practice Location Address
First Line	:	7135 N US HIGHWAY 1
Second Line	:
City	:	PORT ST JOHN
State	:	FL
Zip	:	32927-5087
Country	:	US
Telephone Number	:	321-631-0300
Fax Number	:	321-631-2728

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/06/2018

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Directions to “ MR. KAUSHIK GHAYAL R.PH” Practice Location

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