Provider Demographics
NPI:1316369705
Name:AGRAWAL, NILESH (RPH)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:
Last Name:AGRAWAL
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 1:5250 W INDIAN SCHOOL RD
Mailing Address - Street 2:PHARMACY DEPARTMENT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2605
Mailing Address - Country:US
Mailing Address - Phone:623-845-8724
Mailing Address - Fax:623-845-8726
Practice Address - Street 1:5250 W INDIAN SCHOOL RD
Practice Address - Street 2:PHARMACY DEPARTMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2605
Practice Address - Country:US
Practice Address - Phone:623-845-8724
Practice Address - Fax:623-845-8726
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015356183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist