Provider Demographics
NPI:1871875484
Name:RAVAL, PURNENDU P (PHARM D)
Entity type:Individual
Prefix:DR
First Name:PURNENDU
Middle Name:P
Last Name:RAVAL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W 225TH ST
Mailing Address - Street 2:TARGET PHARMACY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7016
Mailing Address - Country:US
Mailing Address - Phone:718-733-6927
Mailing Address - Fax:347-708-7615
Practice Address - Street 1:40 W 225TH ST
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7016
Practice Address - Country:US
Practice Address - Phone:718-733-6927
Practice Address - Fax:347-708-7615
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056150183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist