MEDICARE: JAGDISHKUMAR THEKDI

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	S014749	AZ

General Provider Information

NPI Number	:	1942623392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGDISHKUMAR THEKDI

Provider Business Mailing Address
First Line	:	8335 E GUADALUPE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-9630
Country	:	US
Telephone Number	:	480-357-9583
Fax Number	:	480-357-9781

Provider Business Practice Location Address
First Line	:	8335 E GUADALUPE RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-9630
Country	:	US
Telephone Number	:	480-357-9583
Fax Number	:	480-357-9781

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

Provider Enumeration Date	:	01/21/2014
Last Update Date	:	01/21/2014

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