Provider Demographics
NPI:1619579927
Name:PRASATIK, TROY LADON (RPH)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:LADON
Last Name:PRASATIK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 HIGHWAY 59 LOOP N
Mailing Address - Street 2:
Mailing Address - City:WHARTON
Mailing Address - State:TX
Mailing Address - Zip Code:77488-7810
Mailing Address - Country:US
Mailing Address - Phone:979-532-0641
Mailing Address - Fax:979-532-0869
Practice Address - Street 1:1255 HIGHWAY 59 LOOP N
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-7810
Practice Address - Country:US
Practice Address - Phone:979-532-0641
Practice Address - Fax:979-532-0869
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist