Provider Demographics
NPI:1013222546
Name:AGRAWAL, PRADIP N (RPH)
Entity Type:Individual
Prefix:
First Name:PRADIP
Middle Name:N
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 1:123 S REEDS RD
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3422
Mailing Address - Country:US
Mailing Address - Phone:609-652-3203
Mailing Address - Fax:609-645-8933
Practice Address - Street 1:505 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232
Practice Address - Country:US
Practice Address - Phone:609-641-9356
Practice Address - Fax:609-645-8933
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI21653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist