Healthcare Provider Details

I. General information

NPI: 1619252616
Provider Name (Legal Business Name): AKSHITA KOTA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 ST. GEROGE AVE
RAHWAY NJ
07065
US

IV. Provider business mailing address

786 ST. GEROGE AVE
RAHWAY NJ
07065
US

V. Phone/Fax

Practice location:
  • Phone: 732-499-4582
  • Fax:
Mailing address:
  • Phone: 732-499-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02578800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: