MEDICARE: RAGHAVENDRA BHATNAGAR 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	PS20469	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	308505	OTHER	FL	NABP

General Provider Information

NPI Number	:	1477934255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAGHAVENDRA BHATNAGAR R.PH

Provider Business Mailing Address
First Line	:	6951 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2819
Country	:	US
Telephone Number	:	904-448-8181
Fax Number	:	904-448-6662

Provider Business Practice Location Address
First Line	:	6951 SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2819
Country	:	US
Telephone Number	:	904-448-8181
Fax Number	:	904-448-6662

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

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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