Provider Demographics
NPI:1568690303
Name:AJBANI, PRABODH D (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRABODH
Middle Name:D
Last Name:AJBANI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1773 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-6961
Mailing Address - Country:US
Mailing Address - Phone:718-583-5900
Mailing Address - Fax:718-716-1876
Practice Address - Street 1:1773 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-6961
Practice Address - Country:US
Practice Address - Phone:718-583-5900
Practice Address - Fax:718-716-1876
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040298183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist