Provider Demographics
NPI:1053710715
Name:ITHIKKAT, ANIL (DR)
Entity type:Individual
Prefix:MR
First Name:ANIL
Middle Name:
Last Name:ITHIKKAT
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 NW 16TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3505
Mailing Address - Country:US
Mailing Address - Phone:352-336-3745
Mailing Address - Fax:352-275-5396
Practice Address - Street 1:4115 NW 16TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3505
Practice Address - Country:US
Practice Address - Phone:352-336-3745
Practice Address - Fax:352-275-5396
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist