Provider Demographics
NPI:1932518115
Name:GHODASARA, ANKIT (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANKIT
Middle Name:
Last Name:GHODASARA
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 1:1438 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6493
Mailing Address - Country:US
Mailing Address - Phone:410-781-4720
Mailing Address - Fax:443-287-9230
Practice Address - Street 1:1438 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6493
Practice Address - Country:US
Practice Address - Phone:410-781-4720
Practice Address - Fax:443-287-9230
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist