Healthcare Provider Details

I. General information

NPI: 1619114360
Provider Name (Legal Business Name): SWARNA L PACHIGALLA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2009
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 A1A S
ST AUGUSTINE FL
32080-6933
US

IV. Provider business mailing address

3905 A1A S
ST AUGUSTINE FL
32080-6933
US

V. Phone/Fax

Practice location:
  • Phone: 904-471-5665
  • Fax: 904-471-9706
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43580
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS43580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: