MEDICARE: PEBBLEBROOK INC

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	3336C0003X	Community/Retail Pharmacy	PH30941	FL

General Provider Information

NPI Number	:	1396263299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEBBLEBROOK INC

Provider Business Mailing Address
First Line	:	15215 COLLIER BLVD STE 308
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-6835
Country	:	US
Telephone Number	:	239-331-3836
Fax Number	:	239-692-8213

Provider Business Practice Location Address
First Line	:	4861 GOLDEN GATE PKWY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-6953
Country	:	US
Telephone Number	:	239-331-3836
Fax Number	:	239-692-8213

Authorized Official
Title or Position	:	AUTHORIZED PERSON
Name	:	MR. SURESH CHAUDHARI
Credential	:	RPH
Telephone Number	:	239-331-3836

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	06/05/2021

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Directions to “PEBBLEBROOK INC ” Practice Location

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