Healthcare Provider Details

I. General information

NPI: 1649649393
Provider Name (Legal Business Name): KIRAN PARVATRAO R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 KENNEDY BLVD
MANVILLE NJ
08835-2007
US

IV. Provider business mailing address

931 KENNEDY BLVD
MANVILLE NJ
08835-2007
US

V. Phone/Fax

Practice location:
  • Phone: 908-722-7002
  • Fax: 732-667-7017
Mailing address:
  • Phone: 908-722-7002
  • Fax: 732-667-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02338400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: