MEDICARE: YAKUTA M KHEDA PHARMD

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	RPH022172	GA

General Provider Information

NPI Number	:	1497551683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAKUTA M KHEDA PHARMD

Provider Business Mailing Address
First Line	:	2783 NE 31ST CT
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8545
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2783 NE 31ST CT
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8545
Country	:	US
Telephone Number	:	706-414-2332
Fax Number	:

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

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	02/20/2025

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