Provider Demographics
NPI:1386981314
Name:PARVATIKAR, RAGHU KISHAN (RPH)
Entity type:Individual
Prefix:
First Name:RAGHU
Middle Name:KISHAN
Last Name:PARVATIKAR
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 1:6001 ARGYLE FOREST BLVD
Mailing Address - Street 2:45
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6664
Mailing Address - Country:US
Mailing Address - Phone:904-908-0759
Mailing Address - Fax:904-908-5987
Practice Address - Street 1:6001 ARGYLE FOREST BLVD
Practice Address - Street 2:45
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6664
Practice Address - Country:US
Practice Address - Phone:904-908-0759
Practice Address - Fax:904-908-5987
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist