Individual
PAVEL ALEKSANDROVICH PRUSAKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2639
(614) 722-6063
Mailing address
700 CHILDRENS DR, COLUMBUS, OH 43205-2639
(614) 722-6063
Taxonomy
Speciality
Code
Description
License number
State
1835P0200X
Pediatric Pharmacist
Primary
03334836
OH
Other
Enumeration date
06/11/2021
Last updated
06/11/2021
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