1932806817 NPI number — DR. ADITYA MANI PERUMAL PHARM D

Table of content: DR. ADITYA MANI PERUMAL PHARM D (NPI 1932806817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932806817 NPI number — DR. ADITYA MANI PERUMAL PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERUMAL
Provider First Name:
ADITYA
Provider Middle Name:
MANI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932806817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 HISTORIC BRICK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32095-8020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-386-5975
Provider Business Mailing Address Fax Number:
904-829-2617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 ARAPAHO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32084-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-829-9919
Provider Business Practice Location Address Fax Number:
904-829-2617
Provider Enumeration Date:
02/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PSI37987 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com