Provider Demographics
NPI:1801180021
Name:PATHAK, SWATI
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:
Last Name:PATHAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9531 SOUTH BLVD
Mailing Address - Street 2:T-0762
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6901
Mailing Address - Country:US
Mailing Address - Phone:704-553-2903
Mailing Address - Fax:704-553-2903
Practice Address - Street 1:9531 SOUTH BLVD
Practice Address - Street 2:T-0762
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6901
Practice Address - Country:US
Practice Address - Phone:704-553-2903
Practice Address - Fax:704-553-2903
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist