Provider Demographics
NPI:1528621554
Name:GHODASARA, AMAR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:AMAR
Middle Name:
Last Name:GHODASARA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-0355
Mailing Address - Country:US
Mailing Address - Phone:410-531-9699
Mailing Address - Fax:410-531-6433
Practice Address - Street 1:3900 TEN OAKS RD STE 11
Practice Address - Street 2:
Practice Address - City:GLENELG
Practice Address - State:MD
Practice Address - Zip Code:21737-9758
Practice Address - Country:US
Practice Address - Phone:410-531-9699
Practice Address - Fax:410-531-6433
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist