Provider Demographics
NPI:1285235226
Name:DRAVID, PRAJAKTA
Entity type:Individual
Prefix:
First Name:PRAJAKTA
Middle Name:
Last Name:DRAVID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 GEORGE CLAUSS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1317
Mailing Address - Country:US
Mailing Address - Phone:410-582-9335
Mailing Address - Fax:
Practice Address - Street 1:407 GEORGE CLAUSS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-1317
Practice Address - Country:US
Practice Address - Phone:410-582-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD231381835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD23138OtherPHARMACIST LICENSE