MEDICARE: BRIDGET PARAVATTIL PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	41115	TX

General Provider Information

NPI Number	:	1871586347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET PARAVATTIL PHARM.D.

Provider Business Mailing Address
First Line	:	4402 HOLLAND AVE
Second Line	:	201
City	:	DALLAS
State	:	TX
Zip	:	75219-2175
Country	:	US
Telephone Number	:	214-520-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 N WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-1656
Country	:	US
Telephone Number	:	214-266-0573
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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