Provider Demographics
NPI:1508465535
Name:NARRA, UDAY BHASKAR
Entity Type:Individual
Prefix:
First Name:UDAY BHASKAR
Middle Name:
Last Name:NARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2073 CULLUM PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4435
Mailing Address - Country:US
Mailing Address - Phone:601-913-3547
Mailing Address - Fax:
Practice Address - Street 1:3172 NEW MATHIS RD STE 1
Practice Address - Street 2:
Practice Address - City:ELMENDORF
Practice Address - State:TX
Practice Address - Zip Code:78112-7811
Practice Address - Country:US
Practice Address - Phone:210-794-0099
Practice Address - Fax:210-908-9994
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist