Active NPI
Ravi Kiran Bodavula, RPH
- Pharmacist
- Fleming Island, FL
National Provider Identifier
1699056358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS40423
- Practice address
- 6945 Highway 17
Fleming Island, FL 32003-9316 - Phone
- (904) 864-8000
- NPI assigned
- Sep 7, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS40423 | FL | Primary |
Addresses
Primary practice location
6945 Highway 17
Fleming Island, FL 32003-9316
Mailing address
5940 Shadehill Rd
Jacksonville, FL 32258-5192
Phone (904) 864-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS40423 | FL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318204800000",
"number": "1699056358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5940 SHADEHILL RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322585192",
"telephone_number": "904-864-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6945 HIGHWAY 17",
"city": "FLEMING ISLAND",
"state": "FL",
"postal_code": "320039316",
"telephone_number": "904-864-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODAVULA",
"first_name": "RAVI",
"middle_name": "KIRAN",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-09-07",
"last_updated": "2011-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS40423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fleming Island, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.