Provider Demographics
NPI:1821310764
Name:RAO, DIPAKKUMAR H (RPH)
Entity Type:Individual
Prefix:MR
First Name:DIPAKKUMAR
Middle Name:H
Last Name:RAO
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 1:180 EAST CENTRAL AVE
Mailing Address - Street 2:RT 59
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977
Mailing Address - Country:US
Mailing Address - Phone:845-352-0490
Mailing Address - Fax:845-352-0524
Practice Address - Street 1:180 EAST CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977
Practice Address - Country:US
Practice Address - Phone:845-352-0490
Practice Address - Fax:845-352-0524
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037816183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist