Provider Demographics
NPI:1114201894
Name:BADHRINARAYANAN, PRAMILA
Entity Type:Individual
Prefix:MS
First Name:PRAMILA
Middle Name:
Last Name:BADHRINARAYANAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 N MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4911
Mailing Address - Country:US
Mailing Address - Phone:314-991-3402
Mailing Address - Fax:314-991-8473
Practice Address - Street 1:630 N MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-4911
Practice Address - Country:US
Practice Address - Phone:314-991-3402
Practice Address - Fax:314-991-8473
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0045200183500000X
HI3059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist