Provider Demographics
NPI:1417916669
Name:KOTHARY, VIRAL (PHARMD, BCPS, BCGP)
Entity Type:Individual
Prefix:DR
First Name:VIRAL
Middle Name:
Last Name:KOTHARY
Suffix:
Gender:M
Credentials:PHARMD, BCPS, BCGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7625 MEXICO WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-1236
Mailing Address - Country:US
Mailing Address - Phone:559-431-7972
Mailing Address - Fax:
Practice Address - Street 1:7625 MEXICO WAY
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-1236
Practice Address - Country:US
Practice Address - Phone:559-431-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53998183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No183500000XPharmacy Service ProvidersPharmacist