Healthcare Provider Details

I. General information

NPI: 1588934715
Provider Name (Legal Business Name): SMITHA MEKALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10401 LITTLE RD
NEW PORT RICHEY FL
34654-2505
US

IV. Provider business mailing address

10401 LITTLE RD
NEW PORT RICHEY FL
34654-2505
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-2588
  • Fax: 727-819-2595
Mailing address:
  • Phone: 727-819-2588
  • Fax: 727-819-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40507
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20109
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: