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General NPI Number Information
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NPI Number | 1336437938
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Entity Type | Individual
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Provider Name | ASHOK PETTEM B.PHARMACY
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Gender | Male
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Dates
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Enumeration Date | 07/16/2011
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Last Update Date | 07/16/2011
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Provider Practice Location Address
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Address Line | 11710 HENRYETTA CT
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City | WALDORF
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State | MD
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Zip | 20602-4189
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Country | US
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Telephone | 731-910-7729
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Fax |
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Provider Business Mailing Address
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Address Line | 30283 TRIANGLE DR
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-3125
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Country | US
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Telephone | 301-472-1825
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Fax | 301-472-1867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18171
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License Number State | MD
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