Provider Demographics
NPI:1235410721
Name:PARULEKAR, PANKAJ A
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:A
Last Name:PARULEKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 BASSETT PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-8505
Mailing Address - Country:US
Mailing Address - Phone:386-668-4946
Mailing Address - Fax:
Practice Address - Street 1:2091 SAXON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-3229
Practice Address - Country:US
Practice Address - Phone:386-960-8962
Practice Address - Fax:386-960-8966
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist