Healthcare Provider Details

I. General information

NPI: 1790025625
Provider Name (Legal Business Name): HARSH P KOTHARI PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 LAKE STREET PLZ
PENN YAN NY
14527-1811
US

IV. Provider business mailing address

112 HAMPSHIRE DR
PLAINSBORO NJ
08536-4312
US

V. Phone/Fax

Practice location:
  • Phone: 631-662-1781
  • Fax:
Mailing address:
  • Phone: 631-662-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57210
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: