MEDICARE: AARON DANIEL RAGOONANAN

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	PS58693	FL

General Provider Information

NPI Number	:	1790387207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON DANIEL RAGOONANAN

Provider Business Mailing Address
First Line	:	3720 LONGLEAF FOREST LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-6896
Country	:	US
Telephone Number	:	904-994-4682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S GOLDWYN AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-4307
Country	:	US
Telephone Number	:	407-563-9147
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	05/05/2021

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