Provider Demographics
NPI:1588035448
Name:RIKKA, PRATAP
Entity Type:Individual
Prefix:
First Name:PRATAP
Middle Name:
Last Name:RIKKA
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 1:8118 HARFORD RD
Mailing Address - Street 2:STE-B
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5725
Mailing Address - Country:US
Mailing Address - Phone:512-618-0792
Mailing Address - Fax:
Practice Address - Street 1:8118 HARFORD RD STE B
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5725
Practice Address - Country:US
Practice Address - Phone:512-618-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist