Provider Demographics
NPI:1649584525
Name:GAUDANI, SHASHWAT
Entity Type:Individual
Prefix:
First Name:SHASHWAT
Middle Name:
Last Name:GAUDANI
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 1:523 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4512
Mailing Address - Country:US
Mailing Address - Phone:732-986-1719
Mailing Address - Fax:
Practice Address - Street 1:416 US-1 NORTH
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-985-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03285200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist