Provider Demographics
NPI:1760868756
Name:THAKAR, HARIVANSH
Entity Type:Individual
Prefix:
First Name:HARIVANSH
Middle Name:
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 1:1000 DULUTH HIGHWAY
Mailing Address - Street 2:APT 2103
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8809
Mailing Address - Country:US
Mailing Address - Phone:678-294-7868
Mailing Address - Fax:
Practice Address - Street 1:1201 TURNER MCCALL BLVD SE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5278
Practice Address - Country:US
Practice Address - Phone:706-232-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist