Provider Demographics
NPI:1508457623
Name:JOSHI, PRITI
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:
Last Name:JOSHI
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 1:3362 FOREST VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4652
Mailing Address - Country:US
Mailing Address - Phone:770-310-1848
Mailing Address - Fax:
Practice Address - Street 1:1190 INDIAN TRAIL RD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-4594
Practice Address - Country:US
Practice Address - Phone:770-638-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019871176P00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No176P00000XOther Service ProvidersFuneral Director