Provider Demographics
NPI:1194478057
Name:PRABHU, RAGHU R (RPH)
Entity type:Individual
Prefix:
First Name:RAGHU
Middle Name:R
Last Name:PRABHU
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 1:2454 ANDERSON HILL ST
Mailing Address - Street 2:
Mailing Address - City:MARRIOTTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21104-1491
Mailing Address - Country:US
Mailing Address - Phone:410-340-0774
Mailing Address - Fax:
Practice Address - Street 1:2454 ANDERSON HILL ST
Practice Address - Street 2:
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1491
Practice Address - Country:US
Practice Address - Phone:410-340-0774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214699183500000X
MD11478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist