MEDICARE: DR. SANJAY GUJRATI PHARM.D

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	15717	NC

General Provider Information

NPI Number	:	1467746248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY GUJRATI PHARM.D

Provider Business Mailing Address
First Line	:	2221 CLOVERDALE AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2301
Country	:	US
Telephone Number	:	336-724-7491
Fax Number	:	336-724-9674

Provider Business Practice Location Address
First Line	:	2221 CLOVERDALE AVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2301
Country	:	US
Telephone Number	:	336-724-7491
Fax Number	:	336-724-9674

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

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	06/08/2011

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