Provider Demographics
NPI:1528388022
Name:CHANDRABATTA, SUBRAMANYAM (MPHARM)
Entity Type:Individual
Prefix:
First Name:SUBRAMANYAM
Middle Name:
Last Name:CHANDRABATTA
Suffix:
Gender:M
Credentials:MPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11845 CARMEL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4602
Mailing Address - Country:US
Mailing Address - Phone:858-451-5711
Mailing Address - Fax:
Practice Address - Street 1:11845 CARMEL MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4602
Practice Address - Country:US
Practice Address - Phone:858-451-5711
Practice Address - Fax:858-451-5620
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH57890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist