Healthcare Provider Details

I. General information

NPI: 1205633724
Provider Name (Legal Business Name): PRAPTI TRIVEDI
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 SHELTON AVE
STATESVILLE NC
28677-6826
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-874-3316
  • Fax:
Mailing address:
  • Phone: 704-874-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23938
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: