Provider Demographics
NPI:1700300506
Name:PHARMASUTRA PLLC
Entity Type:Organization
Organization Name:PHARMASUTRA PLLC
Other - Org Name:GAINESVILLE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVINDER
Authorized Official - Middle Name:PAL
Authorized Official - Last Name:KAHLON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:703-743-5603
Mailing Address - Street 1:7963 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3077
Mailing Address - Country:US
Mailing Address - Phone:703-743-5603
Mailing Address - Fax:
Practice Address - Street 1:7963 HERITAGE VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3077
Practice Address - Country:US
Practice Address - Phone:703-743-5603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010044813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1700300506Medicaid