MEDICARE: MR. SRIDHAR RANGAMANI

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	PH29436	FL

General Provider Information

NPI Number	:	1881068278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SRIDHAR RANGAMANI

Provider Business Mailing Address
First Line	:	3707 LAKE WORH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461
Country	:	US
Telephone Number	:	740-707-3624
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 LAKE WORH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461
Country	:	US
Telephone Number	:	740-707-3624
Fax Number	:

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

Provider Enumeration Date	:	11/23/2015
Last Update Date	:	01/06/2016

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