Healthcare Provider Details

I. General information

NPI: 1831589282
Provider Name (Legal Business Name): PAYAL THAKKER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 HIGHLAND ST
MOUNT HOLLY NC
28120-2185
US

IV. Provider business mailing address

617 HIGHLAND ST
MOUNT HOLLY NC
28120-2185
US

V. Phone/Fax

Practice location:
  • Phone: 704-827-6005
  • Fax:
Mailing address:
  • Phone: 704-827-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24782
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35922
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: