MEDICARE: RAGWA ANTONUS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS41922	FL

General Provider Information

NPI Number	:	1033838461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAGWA ANTONUS RPH

Provider Business Mailing Address
First Line	:	8315 RED BUG LAKE RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6860
Country	:	US
Telephone Number	:	407-977-5613
Fax Number	:	407-977-5620

Provider Business Practice Location Address
First Line	:	8315 RED BUG LAKE RD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-6860
Country	:	US
Telephone Number	:	407-590-7084
Fax Number	:	407-977-5620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2022
Last Update Date	:	08/29/2022

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