Healthcare Provider Details

I. General information

NPI: 1740880889
Provider Name (Legal Business Name): HARDIK R VACHHANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 N EXPRESSWAY
GRIFFIN GA
30223-1746
US

IV. Provider business mailing address

325 NIBLEWILL PL
MARIETTA GA
30066-8603
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-8517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH031461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: