Provider Demographics
NPI:1497204671
Name:RANI, SUBHADRA
Entity Type:Individual
Prefix:
First Name:SUBHADRA
Middle Name:
Last Name:RANI
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 1:16055 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8053
Mailing Address - Country:US
Mailing Address - Phone:909-428-1400
Mailing Address - Fax:909-428-1500
Practice Address - Street 1:16055 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8053
Practice Address - Country:US
Practice Address - Phone:909-428-1400
Practice Address - Fax:909-428-1500
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist