MEDICARE: ATULKUMAR R MALAVIA RPH

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	PS40461	FL

General Provider Information

NPI Number	:	1992060792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATULKUMAR R MALAVIA RPH

Provider Business Mailing Address
First Line	:	10715 PICTORIAL PARK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-2567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 MLK BLVD
Second Line	:
City	:	SEFFNER
State	:	FL
Zip	:	33584-4534
Country	:	US
Telephone Number	:	813-651-1588
Fax Number	:

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

Provider Enumeration Date	:	07/08/2012
Last Update Date	:	07/08/2012

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