Provider Demographics
NPI:1477007714
Name:GRANDHI, APARAJITHA
Entity Type:Individual
Prefix:
First Name:APARAJITHA
Middle Name:
Last Name:GRANDHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:APARANJITHA
Other - Middle Name:
Other - Last Name:NAGISETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1432 YALE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3137
Mailing Address - Country:US
Mailing Address - Phone:810-515-0763
Mailing Address - Fax:
Practice Address - Street 1:11727 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1202
Practice Address - Country:US
Practice Address - Phone:310-444-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist