Provider Demographics
NPI:1821692807
Name:JAGANI, MEHEBOOB RAMZANALI
Entity Type:Individual
Prefix:MR
First Name:MEHEBOOB
Middle Name:RAMZANALI
Last Name:JAGANI
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 1:1891 LPGA BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7108
Mailing Address - Country:US
Mailing Address - Phone:386-274-1490
Mailing Address - Fax:
Practice Address - Street 1:1891 LPGA BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7108
Practice Address - Country:US
Practice Address - Phone:386-274-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist