Provider Demographics
NPI:1578017117
Name:INGRAM DARASAW, PAULA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:
Last Name:INGRAM DARASAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 LOCKBURY CT
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3189
Mailing Address - Country:US
Mailing Address - Phone:919-308-9638
Mailing Address - Fax:
Practice Address - Street 1:4840 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5281
Practice Address - Country:US
Practice Address - Phone:919-308-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist