Provider Demographics
NPI:1982481685
Name:AHMAD, KANITA
Entity Type:Individual
Prefix:
First Name:KANITA
Middle Name:
Last Name:AHMAD
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 1:6015 HARTWELL CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9779
Mailing Address - Country:US
Mailing Address - Phone:518-982-4192
Mailing Address - Fax:
Practice Address - Street 1:3095 OLD ATLANTA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-2737
Practice Address - Country:US
Practice Address - Phone:770-844-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist