MEDICARE: KRUNAL BHAGAT

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	PS47390	FL

General Provider Information

NPI Number	:	1841893567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRUNAL BHAGAT

Provider Business Mailing Address
First Line	:	9368 RIVER OTTER DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-8924
Country	:	US
Telephone Number	:	954-980-4925
Fax Number	:

Provider Business Practice Location Address
First Line	:	2403 CLEVELAND AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-4904
Country	:	US
Telephone Number	:	239-332-3050
Fax Number	:

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

Provider Enumeration Date	:	11/17/2020
Last Update Date	:	11/17/2020

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Directions to “ KRUNAL BHAGAT ” Practice Location

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