=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376205914
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AKTTA THAKKAR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2021
-----------------------------------------------------
Last Update Date | 10/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4470 ROYAL PINE DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-445-4160
-----------------------------------------------------
Fax | 719-445-4166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4470 ROYAL PINE DR
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-2829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-445-4160
-----------------------------------------------------
Fax | 719-445-4166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PHA.0023787
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------