Provider Demographics
NPI:1306483490
Name:DHANANI, VIVEKKUMAR VASANTBHAI
Entity type:Individual
Prefix:
First Name:VIVEKKUMAR
Middle Name:VASANTBHAI
Last Name:DHANANI
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 1:2870 N TOWNE AVE APT 176
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2040
Mailing Address - Country:US
Mailing Address - Phone:201-920-2104
Mailing Address - Fax:
Practice Address - Street 1:17500 FOOTHILL BLVD STE A-7A
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3736
Practice Address - Country:US
Practice Address - Phone:909-222-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist