Provider Demographics
NPI:1639477474
Name:SHEKHAWAT, GAURAV (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:SHEKHAWAT
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ADAMS LAKE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3385
Mailing Address - Country:US
Mailing Address - Phone:862-812-4666
Mailing Address - Fax:
Practice Address - Street 1:3055 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-4565
Practice Address - Country:US
Practice Address - Phone:404-767-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH025134OtherPHARMACIST