Provider Demographics
NPI:1871153874
Name:KOYANI, PRASHANT AMRUTLAL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PRASHANT
Middle Name:AMRUTLAL
Last Name:KOYANI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1016
Mailing Address - Country:US
Mailing Address - Phone:619-343-0095
Mailing Address - Fax:619-830-4590
Practice Address - Street 1:1530 PALM AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1016
Practice Address - Country:US
Practice Address - Phone:619-343-0095
Practice Address - Fax:619-830-4590
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55807183500000X
CA77902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist