Provider Demographics
NPI:1427119221
Name:NIRMAL, GAUTAM KUMAR (RPH)
Entity type:Individual
Prefix:MR
First Name:GAUTAM
Middle Name:KUMAR
Last Name:NIRMAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:51 RAMBLING DR
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2957
Mailing Address - Country:US
Mailing Address - Phone:718-953-4548
Mailing Address - Fax:718-953-4601
Practice Address - Street 1:828 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4403
Practice Address - Country:US
Practice Address - Phone:718-493-8833
Practice Address - Fax:718-604-1392
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist