Provider Demographics
NPI:1891923355
Name:CHAUDHARI, MAHENDRA J (RPH, CCP)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:J
Last Name:CHAUDHARI
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11673 PLANTATION PRESERVE CIR S
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-8372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18911 S TAMIAMI TRL STE 13
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4739
Practice Address - Country:US
Practice Address - Phone:239-658-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH297773336C0003X
FLPS511533336L0003X
NJ28RI026302001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2186868OtherCLIA WAIVER CERTIFICATION
FL1073903233OtherNPPES
FL1891152989OtherNPPES