Provider Demographics
NPI:1407279292
Name:RAVANI, PANKAJKUMAR
Entity Type:Individual
Prefix:
First Name:PANKAJKUMAR
Middle Name:
Last Name:RAVANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325
Mailing Address - Country:US
Mailing Address - Phone:864-387-7151
Mailing Address - Fax:864-342-7938
Practice Address - Street 1:202 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2304
Practice Address - Country:US
Practice Address - Phone:864-387-7151
Practice Address - Fax:864-342-7938
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14304183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist