MEDICARE: KSHAMA S JAYASURIYA R.PH

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	5302036004	MI

General Provider Information

NPI Number	:	1497832828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KSHAMA S JAYASURIYA R.PH

Provider Business Mailing Address
First Line	:	39450 W 12 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3600
Country	:	US
Telephone Number	:	248-344-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	39450 W 12 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-3600
Country	:	US
Telephone Number	:	248-344-0705
Fax Number	:	248-344-0735

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	03/02/2011

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Directions to “ KSHAMA S JAYASURIYA R.PH” Practice Location

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