Provider Demographics
NPI:1073882759
Name:RATHOD, KIRTIDA
Entity Type:Individual
Prefix:
First Name:KIRTIDA
Middle Name:
Last Name:RATHOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 N PEBBLE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5350
Mailing Address - Country:US
Mailing Address - Phone:813-634-8393
Mailing Address - Fax:813-642-9066
Practice Address - Street 1:705 N PEBBLE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5350
Practice Address - Country:US
Practice Address - Phone:813-634-8393
Practice Address - Fax:813-642-9066
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-24
Last Update Date:2011-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist