Individual
MAHENDRA J CHAUDHARI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH, CCP
Contact information
Practice address
18911 S TAMIAMI TRL STE 13, FORT MYERS, FL 33908-4739
(239) 658-1048
Mailing address
11673 PLANTATION PRESERVE CIR S, FORT MYERS, FL 33966-8372
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
28RI02630200
NJ
3336C0003X
Community/Retail Pharmacy
PH29777
FL
3336L0003X
Long Term Care Pharmacy
PS51153
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073903233
NPPES
FL
01
—
10D2186868
CLIA WAIVER CERTIFICATION
FL
01
—
1891152989
NPPES
FL
Enumeration date
06/23/2009
Last updated
07/29/2020
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