Provider Demographics
NPI:1154617157
Name:SAHA, PRABIR KUMAR
Entity type:Individual
Prefix:
First Name:PRABIR
Middle Name:KUMAR
Last Name:SAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 DECKER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-2311
Mailing Address - Country:US
Mailing Address - Phone:803-788-3728
Mailing Address - Fax:803-788-4219
Practice Address - Street 1:2300 DECKER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-2311
Practice Address - Country:US
Practice Address - Phone:803-788-3728
Practice Address - Fax:803-788-4219
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist