Provider Demographics
NPI:1699200584
Name:DEO, PRATIMA
Entity Type:Individual
Prefix:MRS
First Name:PRATIMA
Middle Name:
Last Name:DEO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25289 GOLD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5460
Mailing Address - Country:US
Mailing Address - Phone:510-449-2820
Mailing Address - Fax:
Practice Address - Street 1:25289 GOLD HILLS DR
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5460
Practice Address - Country:US
Practice Address - Phone:510-449-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45384183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist