Provider Demographics
NPI:1770989626
Name:PAI, DHVANI G
Entity type:Individual
Prefix:
First Name:DHVANI
Middle Name:G
Last Name:PAI
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 1:600 RIVER BIRCH CT
Mailing Address - Street 2:APT 827
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5166
Mailing Address - Country:US
Mailing Address - Phone:954-812-3766
Mailing Address - Fax:
Practice Address - Street 1:2615 BURNSED BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2705
Practice Address - Country:US
Practice Address - Phone:352-643-4067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist