Healthcare Provider Details

I. General information

NPI: 1083215610
Provider Name (Legal Business Name): ROSHNI DHOLAKIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HARRISON AVE
KEARNY NJ
07032-5950
US

IV. Provider business mailing address

7002 KENNEDY BLVD E APT 9F
GUTTENBERG NJ
07093-4909
US

V. Phone/Fax

Practice location:
  • Phone: 201-955-0162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03389800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: