Provider Demographics
NPI:1205619525
Name:PRABHU, SONAL NILESH (RPH)
Entity type:Individual
Prefix:
First Name:SONAL
Middle Name:NILESH
Last Name:PRABHU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WAGON TRL E
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9129
Mailing Address - Country:US
Mailing Address - Phone:614-805-3819
Mailing Address - Fax:
Practice Address - Street 1:2872 W BROAD ST STE 101
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-2645
Practice Address - Country:US
Practice Address - Phone:614-279-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist