MEDICARE: PRANATHI CHEEMAKURTHI 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	PS41198	FL

General Provider Information

NPI Number	:	1427343052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRANATHI CHEEMAKURTHI RPH

Provider Business Mailing Address
First Line	:	1520 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2006
Country	:	US
Telephone Number	:	904-739-0390
Fax Number	:	904-739-0663

Provider Business Practice Location Address
First Line	:	1520 UNIVERSITY BLVD W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-2006
Country	:	US
Telephone Number	:	904-739-0390
Fax Number	:	904-739-0663

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

Provider Enumeration Date	:	06/11/2011
Last Update Date	:	06/11/2011

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