MEDICARE: MS. MADHUMATHI PULLELA 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	PS41660	FL

General Provider Information

NPI Number	:	1245648039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MADHUMATHI PULLELA RPH

Provider Business Mailing Address
First Line	:	20052 HERITAGE POINT DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3343
Country	:	US
Telephone Number	:	813-435-3463
Fax Number	:

Provider Business Practice Location Address
First Line	:	20052 HERITAGE POINT DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3343
Country	:	US
Telephone Number	:	813-435-3463
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	03/28/2022

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