Provider Demographics
NPI:1235554080
Name:KAMDAR, GUNJAN
Entity Type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
Last Name:KAMDAR
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 1:105 CHESAPEAKE RIDGE LN
Mailing Address - Street 2:APT. 1A
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-2342
Mailing Address - Country:US
Mailing Address - Phone:732-310-0324
Mailing Address - Fax:
Practice Address - Street 1:8606 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3021
Practice Address - Country:US
Practice Address - Phone:410-238-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist