MEDICARE: RANDA GAD ELRAB

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	PS46681	FL

General Provider Information

NPI Number	:	1528602943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDA GAD ELRAB

Provider Business Mailing Address
First Line	:	28500 STATE ROAD 54
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3210
Country	:	US
Telephone Number	:	813-262-6844
Fax Number	:	813-262-2182

Provider Business Practice Location Address
First Line	:	28500 STATE ROAD 54
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33543-3210
Country	:	US
Telephone Number	:	813-262-6844
Fax Number	:	813-262-2182

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

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	10/29/2019

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