Healthcare Provider Details

I. General information

NPI: 1326302480
Provider Name (Legal Business Name): JIGNESHGIRI ASHVINGIRI GOSAI RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 MOUNT HOLLY RD STE 107
BURLINGTON TOWNSHIP NJ
08016-4705
US

IV. Provider business mailing address

2005 MOUNT HOLLY RD STE 107
BURLINGTON TOWNSHIP NJ
08016-4705
US

V. Phone/Fax

Practice location:
  • Phone: 856-282-2005
  • Fax: 856-203-6165
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20500
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: