Provider Demographics
NPI:1194914572
Name:THAKKAR, GAUTAM (RPH)
Entity type:Individual
Prefix:MR
First Name:GAUTAM
Middle Name:
Last Name:THAKKAR
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 1:19107 HARBOR COVE CT
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9702
Mailing Address - Country:US
Mailing Address - Phone:813-454-3500
Mailing Address - Fax:352-610-4349
Practice Address - Street 1:19107 HARBOR COVE CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-9702
Practice Address - Country:US
Practice Address - Phone:813-454-3500
Practice Address - Fax:813-856-4545
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU6132183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist