MEDICARE: LAKSHMI PERI

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	PS0040819	FL

General Provider Information

NPI Number	:	1558496257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKSHMI PERI

Provider Business Mailing Address
First Line	:	2109 S CRANBROOK AVE
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-3015
Country	:	US
Telephone Number	:	904-230-8125
Fax Number	:

Provider Business Practice Location Address
First Line	:	11101 SAINT AUGUSTINE RD
Second Line	:	WINN DIXIE 179
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1159
Country	:	US
Telephone Number	:	904-260-9755
Fax Number	:	904-260-4385

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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Directions to “ LAKSHMI PERI ” Practice Location

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