MEDICARE: KISHAN J HADVANI

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	S026741	AZ

General Provider Information

NPI Number	:	1881476406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHAN J HADVANI

Provider Business Mailing Address
First Line	:	1830 E BROADWAY BLVD STE 136
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-5968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 E BROADWAY BLVD STE 136
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-5968
Country	:	US
Telephone Number	:	520-330-3451
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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Directions to “ KISHAN J HADVANI ” Practice Location

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