MEDICARE: AMITA GHANTA PHARM D.

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	PS44232	FL

General Provider Information

NPI Number	:	1710636659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMITA GHANTA PHARM D.

Provider Business Mailing Address
First Line	:	1550 SE FLORESTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4069
Country	:	US
Telephone Number	:	772-340-4142
Fax Number	:	772-785-5753

Provider Business Practice Location Address
First Line	:	1550 SE FLORESTA DR
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-4069
Country	:	US
Telephone Number	:	772-340-4142
Fax Number	:	772-785-5753

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

Provider Enumeration Date	:	03/19/2022
Last Update Date	:	03/19/2022

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Directions to “ AMITA GHANTA PHARM D.” Practice Location

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