Provider Demographics
NPI:1912213554
Name:VAKA, PRAVEEN (BPHARMACY, MS)
Entity Type:Individual
Prefix:MR
First Name:PRAVEEN
Middle Name:
Last Name:VAKA
Suffix:
Gender:M
Credentials:BPHARMACY, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SKIBO RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3480
Mailing Address - Country:US
Mailing Address - Phone:910-868-6178
Mailing Address - Fax:
Practice Address - Street 1:1600 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-868-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist