Provider Demographics
NPI:1437750122
Name:RAI, ANURADHA
Entity Type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:RAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13805 LEAMAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4219
Mailing Address - Country:US
Mailing Address - Phone:240-643-3955
Mailing Address - Fax:
Practice Address - Street 1:13060 MIDDLEBROOK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2617
Practice Address - Country:US
Practice Address - Phone:301-428-9115
Practice Address - Fax:844-411-6262
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-08
Last Update Date:2020-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist