Healthcare Provider Details

I. General information

NPI: 1730005844
Provider Name (Legal Business Name): RAMESH BABU GATTU PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24840 S TAMIAMI TRL STE 1AND1
BONITA SPRINGS FL
34134-7009
US

IV. Provider business mailing address

6431 ROYAL WOODS DR
FORT MYERS FL
33908-6190
US

V. Phone/Fax

Practice location:
  • Phone: 239-314-0278
  • Fax: 239-314-0279
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37136
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: