Healthcare Provider Details

I. General information

NPI: 1750737334
Provider Name (Legal Business Name): GAURAVKUMAR HEMRAJBHAI CHAUDHARI PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E LISA DR STE C
CHAPARRAL NM
88081-8080
US

IV. Provider business mailing address

11210 SEAN HAGGERTY DR APT 17201
EL PASO TX
79934-3443
US

V. Phone/Fax

Practice location:
  • Phone: 575-824-5242
  • Fax: 575-824-4066
Mailing address:
  • Phone: 917-476-5281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55447
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP8490
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: