MEDICARE: MAHENDRA J CHAUDHARI RPH, CCP

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	3336C0003X	Community/Retail Pharmacy	PH29777	FL
2	3336L0003X	Long Term Care Pharmacy	PS51153	FL
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	28RI02630200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10D2186868	OTHER	FL	CLIA WAIVER CERTIFICATION
2	1073903233	OTHER	FL	NPPES
3	1891152989	OTHER	FL	NPPES

General Provider Information

NPI Number	:	1891923355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHENDRA J CHAUDHARI RPH, CCP

Provider Business Mailing Address
First Line	:	11673 PLANTATION PRESERVE CIR S
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-8372
Country	:	US
Telephone Number	:
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	:	239-658-1048
Fax Number	:

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

Provider Enumeration Date	:	06/23/2009
Last Update Date	:	07/29/2020

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Directions to “ MAHENDRA J CHAUDHARI RPH, CCP” Practice Location

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