Provider Demographics
NPI:1629397856
Name:THAKAR, ATIT BHARAT
Entity Type:Individual
Prefix:MR
First Name:ATIT
Middle Name:BHARAT
Last Name:THAKAR
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 1:2005 MARCOLA RD
Mailing Address - Street 2:APT 48
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2590
Mailing Address - Country:US
Mailing Address - Phone:518-496-6608
Mailing Address - Fax:
Practice Address - Street 1:2130 MARCOLA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2592
Practice Address - Country:US
Practice Address - Phone:541-747-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPI-0010471183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist