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General NPI Number Information
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NPI Number | 1891923355
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Entity Type | Individual
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Provider Name | MAHENDRA J CHAUDHARI RPH, CCP
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Gender | Male
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 18911 S TAMIAMI TRL STE 13
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City | FORT MYERS
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State | FL
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Zip | 33908-4739
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Country | US
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Telephone | 239-658-1048
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Fax |
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Provider Business Mailing Address
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Address Line | 11673 PLANTATION PRESERVE CIR S
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City | FORT MYERS
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State | FL
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Zip | 33966-8372
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Country | US
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Telephone |
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH29777
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PS51153
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 28RI02630200
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License Number State | NJ
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