Provider Demographics
NPI:1609249283
Name:DAVE, HARDIK D
Entity Type:Individual
Prefix:
First Name:HARDIK
Middle Name:D
Last Name:DAVE
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 1:1802 STARGAZE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4546
Mailing Address - Country:US
Mailing Address - Phone:248-854-1027
Mailing Address - Fax:
Practice Address - Street 1:1802 STARGAZE DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4546
Practice Address - Country:US
Practice Address - Phone:248-854-1027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA73743OtherPHARMACIST