=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932694262
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THANVEER REDDY GADWAL PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2018
-----------------------------------------------------
Last Update Date | 09/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9615 SHERRILL ESTATES RD STE B
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-441-8600
-----------------------------------------------------
Fax | 980-441-8625
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9615 SHERRILL ESTATES RD STE B
-----------------------------------------------------
City | HUNTERSVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28078-6552
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-441-8600
-----------------------------------------------------
Fax | 980-441-8625
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 27774
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------