Provider Demographics
NPI:1639490956
Name:OMKARAM, RAMA R
Entity Type:Individual
Prefix:MR
First Name:RAMA
Middle Name:R
Last Name:OMKARAM
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 1:11083 SE 200TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-1671
Mailing Address - Country:US
Mailing Address - Phone:253-981-3494
Mailing Address - Fax:
Practice Address - Street 1:11220 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-4354
Practice Address - Country:US
Practice Address - Phone:253-537-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00067299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist