Provider Demographics
NPI:1164746590
Name:BIRUDARAJ, KONDAMRAJ (RPH,, PHD)
Entity Type:Individual
Prefix:DR
First Name:KONDAMRAJ
Middle Name:
Last Name:BIRUDARAJ
Suffix:
Gender:M
Credentials:RPH,, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 FORINO DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-2357
Mailing Address - Country:US
Mailing Address - Phone:925-639-9944
Mailing Address - Fax:
Practice Address - Street 1:2038 FORINO DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2357
Practice Address - Country:US
Practice Address - Phone:925-639-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-14
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58066183500000X
NJ28RI03223500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist