Provider Demographics
NPI:1942583109
Name:KANSAGRA, HETAL C (RPH)
Entity type:Individual
Prefix:
First Name:HETAL
Middle Name:C
Last Name:KANSAGRA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DOVE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9671
Mailing Address - Country:US
Mailing Address - Phone:609-827-5756
Mailing Address - Fax:
Practice Address - Street 1:12 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2305
Practice Address - Country:US
Practice Address - Phone:856-933-9342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03003200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist