Provider Demographics
NPI:1710184312
Name:AGGARWAL, DEEPAK (RPH)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:AGGARWAL
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 1:504 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3405
Mailing Address - Country:US
Mailing Address - Phone:321-747-0206
Mailing Address - Fax:321-593-4319
Practice Address - Street 1:504 GARDEN STREET
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796
Practice Address - Country:US
Practice Address - Phone:321-747-0206
Practice Address - Fax:321-593-4319
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32032183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist