1558611996 NPI number — AMITKUMAR NARHARIBHAI THAKKAR MS, PHARMD

Table of content: AMITKUMAR NARHARIBHAI THAKKAR MS, PHARMD (NPI 1558611996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558611996 NPI number — AMITKUMAR NARHARIBHAI THAKKAR MS, PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THAKKAR
Provider First Name:
AMITKUMAR
Provider Middle Name:
NARHARIBHAI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, PHARMD
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:
1558611996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 S MAGNOLIA AVE
Provider Second Line Business Mailing Address:
APT 243
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25710 BARTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-799-0591
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2012

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:  67520 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67520 . This is a "PHARMACIST STATE LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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