Provider Demographics
NPI:1649515875
Name:GANDHI, RIMA
Entity type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:GANDHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26023 75TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1118
Mailing Address - Country:US
Mailing Address - Phone:917-589-4420
Mailing Address - Fax:
Practice Address - Street 1:26023 75TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1118
Practice Address - Country:US
Practice Address - Phone:917-589-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0571741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist