Provider Demographics
NPI:1255658449
Name:KANWAR, AJAY
Entity Type:Individual
Prefix:MR
First Name:AJAY
Middle Name:
Last Name:KANWAR
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 1:139 DANIELA CRES
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N9K1E9
Mailing Address - Country:CA
Mailing Address - Phone:519-979-3349
Mailing Address - Fax:
Practice Address - Street 1:7843 W VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-1517
Practice Address - Country:US
Practice Address - Phone:313-554-4491
Practice Address - Fax:313-841-7240
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist