Provider Demographics
NPI:1629102991
Name:SHIRSAT, RAAKHEE NAGESH (RPH, CDM)
Entity Type:Individual
Prefix:MISS
First Name:RAAKHEE
Middle Name:NAGESH
Last Name:SHIRSAT
Suffix:
Gender:F
Credentials:RPH, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MALLARD PATH
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2154
Mailing Address - Country:US
Mailing Address - Phone:631-928-3131
Mailing Address - Fax:
Practice Address - Street 1:593 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-4244
Practice Address - Country:US
Practice Address - Phone:631-473-4907
Practice Address - Fax:631-473-6530
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046313183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist