Provider Demographics
NPI:1699050153
Name:PIRATLA, RAO S (PHARMD)
Entity type:Individual
Prefix:
First Name:RAO
Middle Name:S
Last Name:PIRATLA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 PUTNAM LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1646
Mailing Address - Country:US
Mailing Address - Phone:410-451-0757
Mailing Address - Fax:
Practice Address - Street 1:2322 PUTNAM LN
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1646
Practice Address - Country:US
Practice Address - Phone:410-451-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist