Provider Demographics
NPI:1245773159
Name:DHOLARIA, JAYANT (PHARMD)
Entity type:Individual
Prefix:
First Name:JAYANT
Middle Name:
Last Name:DHOLARIA
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 1:3706 GRAMMERCY PARK DR
Mailing Address - Street 2:APT 237
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-4403
Mailing Address - Country:US
Mailing Address - Phone:201-665-9093
Mailing Address - Fax:
Practice Address - Street 1:3706 GRAMMERCY PARK DR
Practice Address - Street 2:APT 237
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4403
Practice Address - Country:US
Practice Address - Phone:201-665-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-25
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist