Provider Demographics
NPI:1134581523
Name:THAKKAR, AMISHI
Entity type:Individual
Prefix:
First Name:AMISHI
Middle Name:
Last Name:THAKKAR
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 1:1155 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-2757
Mailing Address - Country:US
Mailing Address - Phone:817-354-2427
Mailing Address - Fax:817-354-9724
Practice Address - Street 1:1155 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-2757
Practice Address - Country:US
Practice Address - Phone:817-354-2427
Practice Address - Fax:817-354-9724
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist