Provider Demographics
NPI:1053917203
Name:GADA, AMISH (RPH)
Entity type:Individual
Prefix:MR
First Name:AMISH
Middle Name:
Last Name:GADA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1877
Mailing Address - Country:US
Mailing Address - Phone:732-606-0990
Mailing Address - Fax:732-606-9479
Practice Address - Street 1:431 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-1877
Practice Address - Country:US
Practice Address - Phone:732-606-0990
Practice Address - Fax:732-606-9479
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02680400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist