Provider Demographics
NPI:1316564545
Name:KHOLWADWALA, VISHAL (PHARMD)
Entity Type:Individual
Prefix:
First Name:VISHAL
Middle Name:
Last Name:KHOLWADWALA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3568
Mailing Address - Country:US
Mailing Address - Phone:575-885-2979
Mailing Address - Fax:575-885-5714
Practice Address - Street 1:2402 W PIERCE ST STE 2B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3568
Practice Address - Country:US
Practice Address - Phone:575-885-2979
Practice Address - Fax:575-885-5714
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist