Healthcare Provider Details

I. General information

NPI: 1255658449
Provider Name (Legal Business Name): MR. AJAY KANWAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7843 W VERNOR HWY
DETROIT MI
48209-1517
US

IV. Provider business mailing address

139 DANIELA CRES
TECUMSEH ONTARIO
N9K1E9
CA

V. Phone/Fax

Practice location:
  • Phone: 313-554-4491
  • Fax: 313-841-7240
Mailing address:
  • Phone: 519-979-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302032042
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: