MEDICARE: MR. RAJKUMAR MOTHE

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	PS63553	FL

General Provider Information

NPI Number	:	1649900226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAJKUMAR MOTHE

Provider Business Mailing Address
First Line	:	18911 S TAMIAMI TRL STE 13
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4739
Country	:	US
Telephone Number	:	239-590-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	18911 S TAMIAMI TRL STE 13
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4739
Country	:	US
Telephone Number	:	239-590-8820
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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Directions to “ MR. RAJKUMAR MOTHE ” Practice Location

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