Provider Demographics
NPI:1245513829
Name:GANDHI, NIRAVKUMAR R (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:NIRAVKUMAR
Middle Name:R
Last Name:GANDHI
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:NIRAVKUMAR
Other - Middle Name:R
Other - Last Name:GANDHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:6003 WESTKNOLL DR
Mailing Address - Street 2:APT 639
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5334
Mailing Address - Country:US
Mailing Address - Phone:810-965-2666
Mailing Address - Fax:
Practice Address - Street 1:3424 E GENESEE AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4211
Practice Address - Country:US
Practice Address - Phone:989-753-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036552183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist