Healthcare Provider Details

I. General information

NPI: 1306115266
Provider Name (Legal Business Name): KALPESH DAVE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MAIN ST AMERICARE PRESCRIPTION SURGICAL CTR
FORT LEE NJ
07024-4504
US

IV. Provider business mailing address

113 MACDONALD DR
WAYNE NJ
07470-3962
US

V. Phone/Fax

Practice location:
  • Phone: 201-461-2472
  • Fax: 201-461-0097
Mailing address:
  • Phone: 201-461-2472
  • Fax: 201-461-0097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03145000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: