Provider Demographics
NPI:1578834115
Name:VAIDYANATHAN, RAMDAS (DPH)
Entity Type:Individual
Prefix:
First Name:RAMDAS
Middle Name:
Last Name:VAIDYANATHAN
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 28TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-5155
Mailing Address - Country:US
Mailing Address - Phone:425-283-3229
Mailing Address - Fax:
Practice Address - Street 1:5409 15TH AVE NW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3810
Practice Address - Country:US
Practice Address - Phone:206-781-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00048652183500000X
ORRPH-0010168183500000X
OKR-12532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist