Provider Demographics
NPI:1932806817
Name:PERUMAL, ADITYA MANI (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:MANI
Last Name:PERUMAL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HISTORIC BRICK LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8020
Mailing Address - Country:US
Mailing Address - Phone:904-386-5975
Mailing Address - Fax:904-829-2617
Practice Address - Street 1:1201 ARAPAHO AVE
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4203
Practice Address - Country:US
Practice Address - Phone:904-829-9919
Practice Address - Fax:904-829-2617
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI37987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist