Provider Demographics
NPI:1649649393
Name:PARVATRAO, KIRAN (RPH)
Entity type:Individual
Prefix:MR
First Name:KIRAN
Middle Name:
Last Name:PARVATRAO
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 1:931 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-2007
Mailing Address - Country:US
Mailing Address - Phone:908-722-7002
Mailing Address - Fax:732-667-7017
Practice Address - Street 1:931 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:MANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08835-2007
Practice Address - Country:US
Practice Address - Phone:908-722-7002
Practice Address - Fax:732-667-7017
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02338400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist