MEDICARE: INDRAVADAN THAKKER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	34970	NY

General Provider Information

NPI Number	:	1063734697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDRAVADAN THAKKER RPH

Provider Business Mailing Address
First Line	:	39 VIRGINIA AVE
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-1901
Country	:	US
Telephone Number	:	201-501-8462
Fax Number	:	201-501-8462

Provider Business Practice Location Address
First Line	:	1980 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-3663
Country	:	US
Telephone Number	:	212-369-6075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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