Provider Demographics
NPI:1295142313
Name:PRASHANT, KAVITA
Entity type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:PRASHANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAVITA
Other - Middle Name:
Other - Last Name:REIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:66 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CA
Mailing Address - Zip Code:95570-9794
Mailing Address - Country:US
Mailing Address - Phone:707-464-1452
Mailing Address - Fax:707-464-1627
Practice Address - Street 1:900 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8118
Practice Address - Country:US
Practice Address - Phone:707-464-1452
Practice Address - Fax:707-464-1627
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist