Provider Demographics
NPI:1184758849
Name:GUJJA, PAVITHRAN (RPH)
Entity type:Individual
Prefix:MR
First Name:PAVITHRAN
Middle Name:
Last Name:GUJJA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HAUT BRION AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5927
Mailing Address - Country:US
Mailing Address - Phone:302-489-9045
Mailing Address - Fax:
Practice Address - Street 1:4528 KIRKWOOD HWY
Practice Address - Street 2:SUITE A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1928
Practice Address - Country:US
Practice Address - Phone:302-575-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist