Provider Demographics
NPI:1942349998
Name:ANIL G INDULKAR PHARMACIST APC
Entity Type:Organization
Organization Name:ANIL G INDULKAR PHARMACIST APC
Other - Org Name:AVALON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-365-7621
Mailing Address - Street 1:58471 29 PALMS HWY
Mailing Address - Street 2:STE 301
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-5818
Mailing Address - Country:US
Mailing Address - Phone:760-365-7621
Mailing Address - Fax:760-365-7622
Practice Address - Street 1:58471 29 PALMS HWY
Practice Address - Street 2:STE 301
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-5818
Practice Address - Country:US
Practice Address - Phone:760-365-7621
Practice Address - Fax:760-365-7622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY466773336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2005338OtherPK
2005338OtherPK