Provider Demographics
NPI:1063704377
Name:DASH, DEEPAK PRAFULLA (RPH)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:PRAFULLA
Last Name:DASH
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 1:602 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-1927
Mailing Address - Country:US
Mailing Address - Phone:831-784-1606
Mailing Address - Fax:
Practice Address - Street 1:6498 PONY EXPRESS TRL
Practice Address - Street 2:
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726-9604
Practice Address - Country:US
Practice Address - Phone:530-647-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA123456789Medicaid