Provider Demographics
NPI:1104001817
Name:RAVAL, DEVANG LAHERI (RPH)
Entity Type:Individual
Prefix:
First Name:DEVANG
Middle Name:LAHERI
Last Name:RAVAL
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 1:1706B ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1206
Mailing Address - Country:US
Mailing Address - Phone:718-221-2608
Mailing Address - Fax:718-221-2972
Practice Address - Street 1:1706B ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1206
Practice Address - Country:US
Practice Address - Phone:718-221-2608
Practice Address - Fax:718-221-2972
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041105-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02489527Medicaid
NY5119390001Medicare UPIN