Provider Demographics
NPI:1396030755
Name:GUJARATHI, KRUTIKA VIKRAM
Entity Type:Individual
Prefix:MRS
First Name:KRUTIKA
Middle Name:VIKRAM
Last Name:GUJARATHI
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 1:6530 INDEPENDENCE AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2984
Mailing Address - Country:US
Mailing Address - Phone:818-704-7671
Mailing Address - Fax:
Practice Address - Street 1:8230 TOPANGA CANYON,
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304
Practice Address - Country:US
Practice Address - Phone:818-348-5126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist