Healthcare Provider Details

I. General information

NPI: 1497551683
Provider Name (Legal Business Name): YAKUTA M KHEDA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2783 NE 31ST CT
LIGHTHOUSE POINT FL
33064-8545
US

IV. Provider business mailing address

2783 NE 31ST CT
LIGHTHOUSE POINT FL
33064-8545
US

V. Phone/Fax

Practice location:
  • Phone: 706-414-2332
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH022172
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: