=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750737334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAURAVKUMAR HEMRAJBHAI CHAUDHARI PHARM.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2016
-----------------------------------------------------
Last Update Date | 09/01/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 E LISA DR STE C
-----------------------------------------------------
City | CHAPARRAL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88081-8080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-824-5242
-----------------------------------------------------
Fax | 575-824-4066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11210 SEAN HAGGERTY DR APT 17201
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79934-3443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-476-5281
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 55447
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP8490
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------