MEDICARE: MR. SHELDON JAGGERNAUTH 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	PS36980	FL

General Provider Information

NPI Number	:	1467797076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHELDON JAGGERNAUTH RPH

Provider Business Mailing Address
First Line	:	1575 LAND O LAKES BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2930
Country	:	US
Telephone Number	:	813-949-3664
Fax Number	:	813-949-4238

Provider Business Practice Location Address
First Line	:	1575 LAND O LAKES BLVD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33549-2930
Country	:	US
Telephone Number	:	813-949-3664
Fax Number	:	813-949-4238

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

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	12/07/2012

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