Provider Demographics
NPI:1235426743
Name:PRASAD, NEEL AVINESH (PHARMD)
Entity Type:Individual
Prefix:
First Name:NEEL
Middle Name:AVINESH
Last Name:PRASAD
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 1:3405 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1445
Mailing Address - Country:US
Mailing Address - Phone:209-523-6210
Mailing Address - Fax:
Practice Address - Street 1:3405 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1445
Practice Address - Country:US
Practice Address - Phone:209-523-6210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist