MEDICARE: KAILASHRX LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922635424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAILASHRX LLC

Provider Business Mailing Address
First Line	:	1240 PROVIDENCE BLVD
Second Line	:	UNIT 1 & 2
City	:	DELTONA
State	:	FL
Zip	:	32725-7352
Country	:	US
Telephone Number	:	386-259-5435
Fax Number	:	386-259-9582

Provider Business Practice Location Address
First Line	:	1240 PROVIDENCE BLVD
Second Line	:	UNIT 1 & 2
City	:	DELTONA
State	:	FL
Zip	:	32725-7352
Country	:	US
Telephone Number	:	386-259-5435
Fax Number	:	386-259-9582

Authorized Official
Title or Position	:	OWNER/ PHARMACY MANAGER
Name	:	JAYESH MEHTA
Credential	:	MPHARM, RPH
Telephone Number	:	386-259-5435

Provider Enumeration Date	:	03/25/2020
Last Update Date	:	11/02/2022

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Directions to “KAILASHRX LLC ” Practice Location

Language	Start Address	Practice Location

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