Provider Demographics
NPI:1487976379
Name:DESHPANDE, PRAKASH D (RPH)
Entity type:Individual
Prefix:MR
First Name:PRAKASH
Middle Name:D
Last Name:DESHPANDE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:178 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-4235
Mailing Address - Country:US
Mailing Address - Phone:212-228-0764
Mailing Address - Fax:212-529-2859
Practice Address - Street 1:178 AVENUE C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-4235
Practice Address - Country:US
Practice Address - Phone:212-228-0764
Practice Address - Fax:212-529-2859
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI031596-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist