Provider Demographics
NPI:1184173601
Name:THAKER, KHUSHBU P (PHARMD)
Entity type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:P
Last Name:THAKER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CHANLON RD FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1543
Mailing Address - Country:US
Mailing Address - Phone:908-977-9372
Mailing Address - Fax:908-464-5275
Practice Address - Street 1:121 CHANLON RD FL 2
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1543
Practice Address - Country:US
Practice Address - Phone:908-977-9372
Practice Address - Fax:908-464-5275
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451079183500000X
NJ28RI03741900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist