Provider Demographics
NPI:1790057305
Name:WANKHEDE, RAVI A (RPH ,CGP)
Entity Type:Individual
Prefix:MR
First Name:RAVI
Middle Name:A
Last Name:WANKHEDE
Suffix:
Gender:M
Credentials:RPH ,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11208 SILVERSMITH LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2550
Mailing Address - Country:US
Mailing Address - Phone:304-634-9038
Mailing Address - Fax:
Practice Address - Street 1:11208 SILVERSMITH LN
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-2550
Practice Address - Country:US
Practice Address - Phone:304-634-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022083941835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric