MEDICARE: SATIVA GANESH PHARMD, CGP, CPH

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	PS42770	FL
2	1835G0303X	Geriatric Pharmacist	PU7251	FL

General Provider Information

NPI Number	:	1851749659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SATIVA GANESH PHARMD, CGP, CPH

Provider Business Mailing Address
First Line	:	4322 NW 62ND AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3177
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4322 NW 62ND AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-3177
Country	:	US
Telephone Number	:	954-547-8941
Fax Number	:

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

Provider Enumeration Date	:	06/02/2016
Last Update Date	:	06/02/2016

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