Provider Demographics
NPI:1235260902
Name:KOTHARI, GAURAV (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:KOTHARI
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1531
Mailing Address - Country:US
Mailing Address - Phone:201-998-9055
Mailing Address - Fax:
Practice Address - Street 1:1445 UNIONPORT RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4400
Practice Address - Country:US
Practice Address - Phone:347-851-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist