Active NPI
Gautej Koradia, PHARM D
- Pharmacist
- Dallas, TX
National Provider Identifier
1245836832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 55574
- Practice address
- 1235 S Buckner Blvd
Dallas, TX 75217-4306 - Phone
- (469) 865-6106
- NPI assigned
- Dec 8, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 55574 | TX | Primary |
Addresses
Primary practice location
1235 S Buckner Blvd
Dallas, TX 75217-4306
Mailing address
2113 Bennett Ave Unit 40
Dallas, TX 75206-8580
Phone (469) 865-6106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55574 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607385600000",
"number": "1245836832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2113 BENNETT AVE UNIT 40",
"city": "DALLAS",
"state": "TX",
"postal_code": "752068580",
"telephone_number": "469-865-6106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 S BUCKNER BLVD",
"city": "DALLAS",
"state": "TX",
"postal_code": "752174306",
"telephone_number": "469-865-6106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORADIA",
"first_name": "GAUTEJ",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-08",
"last_updated": "2020-12-08",
"certification_date": "2020-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "55574",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.