Provider Demographics
NPI:1518567619
Name:KROTHAPALLI, TARUN KRISHNA (RPH)
Entity Type:Individual
Prefix:
First Name:TARUN KRISHNA
Middle Name:
Last Name:KROTHAPALLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S DR EE DUNLAP ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:TX
Mailing Address - Zip Code:78384-3212
Mailing Address - Country:US
Mailing Address - Phone:361-209-8322
Mailing Address - Fax:361-209-5022
Practice Address - Street 1:500 S DR EE DUNLAP ST STE C
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:TX
Practice Address - Zip Code:78384-3212
Practice Address - Country:US
Practice Address - Phone:361-209-8322
Practice Address - Fax:361-209-5022
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist