Provider Demographics
NPI:1437891165
Name:KOTHIYA, DAXABEN J
Entity Type:Individual
Prefix:
First Name:DAXABEN
Middle Name:J
Last Name:KOTHIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 E PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3538
Mailing Address - Country:US
Mailing Address - Phone:972-424-0067
Mailing Address - Fax:
Practice Address - Street 1:4201 E PARK BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3538
Practice Address - Country:US
Practice Address - Phone:972-424-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69947183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist