Provider Demographics
NPI:1326350588
Name:THAKUR, VINOD KUMAR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:KUMAR
Last Name:THAKUR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3173
Mailing Address - Country:US
Mailing Address - Phone:410-535-5313
Mailing Address - Fax:
Practice Address - Street 1:355 MARKET SQUARE DR
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3173
Practice Address - Country:US
Practice Address - Phone:410-535-5313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19135183500000X
NJ28RI03129300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist