Healthcare Provider Details

I. General information

NPI: 1619373586
Provider Name (Legal Business Name): JAIMIN TAKTAWALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAIMIN TAKTAWALA RPH

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 LAND O LAKES BLVD STE 15
LUTZ FL
33549-2924
US

IV. Provider business mailing address

20125 OAKFLOWER AVE
TAMPA FL
33647-3649
US

V. Phone/Fax

Practice location:
  • Phone: 813-948-4500
  • Fax:
Mailing address:
  • Phone: 813-884-4884
  • Fax: 813-886-1690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: