Provider Demographics
NPI:1154658557
Name:RAO, PAVANKUMAR DIGAMBER (BSPHARM)
Entity Type:Individual
Prefix:MR
First Name:PAVANKUMAR
Middle Name:DIGAMBER
Last Name:RAO
Suffix:
Gender:M
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 RITTIMAN ROAD
Mailing Address - Street 2:WALGREENS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-666-4244
Mailing Address - Fax:210-666-5759
Practice Address - Street 1:6363 RITTIMAN ROAD
Practice Address - Street 2:WALGREENS
Practice Address - City:SANANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218
Practice Address - Country:US
Practice Address - Phone:210-666-4244
Practice Address - Fax:210-666-5759
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist