Provider Demographics
NPI:1245190404
Name:THAKKAR, KUNJ Y
Entity type:Individual
Prefix:
First Name:KUNJ
Middle Name:Y
Last Name:THAKKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-3613
Mailing Address - Country:US
Mailing Address - Phone:203-371-1280
Mailing Address - Fax:203-372-5468
Practice Address - Street 1:3710 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-3613
Practice Address - Country:US
Practice Address - Phone:203-371-1280
Practice Address - Fax:203-372-5468
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0016458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist