MEDICARE: MR. SURESH CHAUDHARI

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	PS35393	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790009819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SURESH CHAUDHARI

Provider Business Mailing Address
First Line	:	6750 PENZANCE BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8351
Country	:	US
Telephone Number	:	239-560-4354
Fax Number	:	239-368-3091

Provider Business Practice Location Address
First Line	:	4861 GOLDEN GATE PKWY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6953
Country	:	US
Telephone Number	:	239-560-4354
Fax Number	:

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

Provider Enumeration Date	:	03/18/2010
Last Update Date	:	02/05/2021

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