1609173301 NPI number — RAJNI B GANDHI PHARMACIST

Table of content: RAJNI B GANDHI PHARMACIST (NPI 1609173301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609173301 NPI number — RAJNI B GANDHI PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDHI
Provider First Name:
RAJNI
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

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:
1609173301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1408 ARCHDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
980-355-0906
Provider Business Mailing Address Fax Number:
704-705-1236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1408 ARCHDALE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28210-4421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-355-0906
Provider Business Practice Location Address Fax Number:
704-705-1236
Provider Enumeration Date:
02/16/2011

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:  13477 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 10781 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10781 . This is a "SOUTH CAROLINA BOARD OF PHARMACY" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 13477 . This is a "NC BOARD OF PHARMACY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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