Provider Demographics
NPI:1942564463
Name:DHRUVA, DEEPAK K (RPH)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:K
Last Name:DHRUVA
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 1:13 N 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1585
Mailing Address - Country:US
Mailing Address - Phone:509-307-5978
Mailing Address - Fax:
Practice Address - Street 1:401 S 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3361
Practice Address - Country:US
Practice Address - Phone:509-965-2336
Practice Address - Fax:509-965-3667
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00039862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist