Provider Demographics
NPI:1295406858
Name:TOUTAM, RUDRANI
Entity Type:Individual
Prefix:
First Name:RUDRANI
Middle Name:
Last Name:TOUTAM
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 1:315 AVON RD APT F201
Mailing Address - Street 2:
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-2320
Mailing Address - Country:US
Mailing Address - Phone:937-344-9334
Mailing Address - Fax:
Practice Address - Street 1:1401 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3173
Practice Address - Country:US
Practice Address - Phone:937-344-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP455446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist