Healthcare Provider Details

I. General information

NPI: 1235260902
Provider Name (Legal Business Name): GAURAV KOTHARI B.S PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 UNIONPORT RD
BRONX NY
10462-4400
US

IV. Provider business mailing address

241 UNION AVE
RUTHERFORD NJ
07070-1531
US

V. Phone/Fax

Practice location:
  • Phone: 347-851-2688
  • Fax:
Mailing address:
  • Phone: 201-998-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number050956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: