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General NPI Number Information
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NPI Number | 1821618281
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Entity Type | Individual
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Provider Name | VIGNESH RAVIKUMAR
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Gender | Male
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 1106 CLEARLAKE RD
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City | COCOA
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State | FL
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Zip | 32922-6402
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Country | US
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Telephone | 321-632-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 26483 BONITA FAIRWAYS BLVD
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7542
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Country | US
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Telephone | 561-336-8069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 59434
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License Number State | FL
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