Provider Demographics
NPI:1174861017
Name:PADIYAR, PRIYA
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:
Last Name:PADIYAR
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 1:2177 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4743
Mailing Address - Country:US
Mailing Address - Phone:916-435-2181
Mailing Address - Fax:
Practice Address - Street 1:2177 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4743
Practice Address - Country:US
Practice Address - Phone:916-435-2181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65541183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist