Healthcare Provider Details

I. General information

NPI: 1255747473
Provider Name (Legal Business Name): RUTI A DWIVEDI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

8512 BANYAN BLVD
ORLANDO FL
32819-4123
US

V. Phone/Fax

Practice location:
  • Phone: 352-271-5000
  • Fax:
Mailing address:
  • Phone: 813-751-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: