Provider Demographics
NPI:1376824177
Name:RAVAL, SUJIT KUMAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SUJIT
Middle Name:KUMAR
Last Name:RAVAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11706 BELLA MILANO CT
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6059
Mailing Address - Country:US
Mailing Address - Phone:321-297-8514
Mailing Address - Fax:407-859-6442
Practice Address - Street 1:7003 PRESIDENTS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5517
Practice Address - Country:US
Practice Address - Phone:407-859-6197
Practice Address - Fax:407-859-6442
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist