Provider Demographics
NPI:1306115266
Name:DAVE, KALPESH (RPH)
Entity type:Individual
Prefix:
First Name:KALPESH
Middle Name:
Last Name:DAVE
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 1:113 MACDONALD DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3962
Mailing Address - Country:US
Mailing Address - Phone:201-461-2472
Mailing Address - Fax:201-461-0097
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:AMERICARE PRESCRIPTION SURGICAL CTR
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-4504
Practice Address - Country:US
Practice Address - Phone:201-461-2472
Practice Address - Fax:201-461-0097
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03145000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist