MEDICARE: VISHAL MODI MS RPH

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	FLPS37679	FL

General Provider Information

NPI Number	:	1508136938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHAL MODI MS RPH

Provider Business Mailing Address
First Line	:	12822 RETORIA CIR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33625-4112
Country	:	US
Telephone Number	:	813-264-2429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 E LAKE RD
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-2401
Country	:	US
Telephone Number	:	727-785-7451
Fax Number	:	727-772-5547

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

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	01/02/2012

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