Provider Demographics
NPI:1245697531
Name:PRASAD, SHLOK NARAYAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHLOK
Middle Name:NARAYAN
Last Name:PRASAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S IMPERIAL AVE
Mailing Address - Street 2:STE #12
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-4242
Mailing Address - Country:US
Mailing Address - Phone:760-353-5130
Mailing Address - Fax:760-353-4556
Practice Address - Street 1:1600 S IMPERIAL AVE
Practice Address - Street 2:STE #12
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4242
Practice Address - Country:US
Practice Address - Phone:760-353-5130
Practice Address - Fax:760-353-4556
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72474183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist