Provider Demographics
NPI:1790380145
Name:GANDHI, AMITA ASHISH (RPH)
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:ASHISH
Last Name:GANDHI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4630
Mailing Address - Country:US
Mailing Address - Phone:781-963-3906
Mailing Address - Fax:
Practice Address - Street 1:171 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4630
Practice Address - Country:US
Practice Address - Phone:781-963-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA24333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist