MEDICARE: NIKUL R PANCHAL

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	PS35632	FL

General Provider Information

NPI Number	:	1437658895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKUL R PANCHAL

Provider Business Mailing Address
First Line	:	19126 WOOD SAGE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3093
Country	:	US
Telephone Number	:	813-482-7700
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 EAGLES LANDING DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2999
Country	:	US
Telephone Number	:	727-896-0001
Fax Number	:

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

Provider Enumeration Date	:	02/12/2018
Last Update Date	:	10/29/2025

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