Provider Demographics
NPI:1659404184
Name:BAFANA, PRASANNA P (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRASANNA
Middle Name:P
Last Name:BAFANA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:PRASANNAKUMAR
Other - Middle Name:P
Other - Last Name:BAFANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6216 FAYETTEVILLE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6287
Mailing Address - Country:US
Mailing Address - Phone:919-908-0200
Mailing Address - Fax:919-908-0205
Practice Address - Street 1:6216 FAYETTEVILLE RD STE 105
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6287
Practice Address - Country:US
Practice Address - Phone:919-908-0200
Practice Address - Fax:919-908-0205
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist