Provider Demographics
NPI:1720376619
Name:PRASAD, AMRITA
Entity Type:Individual
Prefix:MS
First Name:AMRITA
Middle Name:
Last Name:PRASAD
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 1:10521 FAIRFAX BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3138
Mailing Address - Country:US
Mailing Address - Phone:703-273-4515
Mailing Address - Fax:703-273-0556
Practice Address - Street 1:10521 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3138
Practice Address - Country:US
Practice Address - Phone:703-273-4515
Practice Address - Fax:703-273-0556
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist