Provider Demographics
NPI:1033485008
Name:KALAVADIA, DENISHKUMAR PRANLAL
Entity Type:Individual
Prefix:
First Name:DENISHKUMAR
Middle Name:PRANLAL
Last Name:KALAVADIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10088 GULF CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-8961
Mailing Address - Country:US
Mailing Address - Phone:239-433-7249
Mailing Address - Fax:239-433-7246
Practice Address - Street 1:10088 GULF CENTER DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8961
Practice Address - Country:US
Practice Address - Phone:239-433-7249
Practice Address - Fax:239-433-7246
Is Sole Proprietor?:No
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist