Provider Demographics
NPI:1912343021
Name:DATWANI, ANIL (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:
Last Name:DATWANI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 NEW BRUNSWICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863
Mailing Address - Country:US
Mailing Address - Phone:732-738-1085
Mailing Address - Fax:732-738-1068
Practice Address - Street 1:370 NEW BRUNSWICK AVENUE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863
Practice Address - Country:US
Practice Address - Phone:732-738-1085
Practice Address - Fax:732-738-1068
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02837900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist