Provider Demographics
NPI:1770739336
Name:GHODADRA, SWAPNIL DIPAK (RPH)
Entity type:Individual
Prefix:
First Name:SWAPNIL
Middle Name:DIPAK
Last Name:GHODADRA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 RED LION RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1129
Mailing Address - Country:US
Mailing Address - Phone:215-637-1200
Mailing Address - Fax:
Practice Address - Street 1:3200 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1129
Practice Address - Country:US
Practice Address - Phone:215-637-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist