Provider Demographics
NPI:1891087474
Name:THAKKAR, ALI H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALI
Middle Name:H
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4067
Mailing Address - Country:US
Mailing Address - Phone:301-317-3838
Mailing Address - Fax:301-317-3637
Practice Address - Street 1:667 MAIN STREET
Practice Address - Street 2:MAIN STREET PHARMACY
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4067
Practice Address - Country:US
Practice Address - Phone:301-317-3838
Practice Address - Fax:301-317-3637
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist