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Individual

ASHOK PETTEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
B.PHARMACY

Contact information

Practice address
11710 HENRYETTA CT, WALDORF, MD 20602-4189
(731) 910-7729
Mailing address
30283 TRIANGLE DR, CHARLOTTE HALL, MD 20622-3125
(301) 472-1825
(301) 472-1867

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
18171
MD

Other

Enumeration date
07/16/2011
Last updated
07/16/2011
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