Provider Demographics
NPI:1962753376
Name:AMESAR, JANVI PANKAJ
Entity type:Individual
Prefix:
First Name:JANVI
Middle Name:PANKAJ
Last Name:AMESAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 EVERIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6326
Mailing Address - Country:US
Mailing Address - Phone:980-225-2433
Mailing Address - Fax:
Practice Address - Street 1:133 EVERIDGE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6326
Practice Address - Country:US
Practice Address - Phone:980-225-2433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist