MEDICARE: SONAL NILESH PRABHU RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03127662	OH

General Provider Information

NPI Number	:	1205619525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONAL NILESH PRABHU RPH

Provider Business Mailing Address
First Line	:	117 WAGON TRL E
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-9129
Country	:	US
Telephone Number	:	614-805-3819
Fax Number	:

Provider Business Practice Location Address
First Line	:	2872 W BROAD ST STE 101
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2645
Country	:	US
Telephone Number	:	614-279-9550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/18/2023

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