Provider Demographics
NPI:1467736637
Name:RANGA, RAMA S (RPH, PHD)
Entity Type:Individual
Prefix:
First Name:RAMA
Middle Name:S
Last Name:RANGA
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 1:10926 COLLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2307
Mailing Address - Country:US
Mailing Address - Phone:859-536-0669
Mailing Address - Fax:
Practice Address - Street 1:2360 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4018
Practice Address - Country:US
Practice Address - Phone:502-493-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist