Provider Demographics
NPI:1841023629
Name:KAVISH, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KAVISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11227 CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:IL
Mailing Address - Zip Code:62520-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 LEAD HILL BLVD STE 260
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2998
Practice Address - Country:US
Practice Address - Phone:916-237-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0019359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist